Teaching professional ethics in a faith-based doctoral program: pedagogical strategies.

Anderson, Tamara L.

Teaching professional ethics in faith-based doctoral programs is similar to teaching this subject in secular programs, with some exceptions. Defining what is meant by "faith-based program," this article discusses unique issues relevant to teaching Christian psychologists in training, as well as two specific pedagogical strategies: inviting students to assess their ethical decision-making heritage, and creative use of vignettes.

What is a Faith-Based Clinical Psychology Program, Anyway?

The usual readership of the Journal of Psychology and Theology may find this question painfully obvious. However, I believe a discussion of what is meant by the term faith-based may provide a helpful context for the discussion on training professional ethics in such a program. In providing this context I am seeking to address concerns that secular colleagues may harbor regarding programs that integrate faith and profession. Possibly, such a brief discussion might benefit a reader who is historically unfamiliar with faith-based clinical psychology programs and particularly concerned with the ethical training and behavior of psychologists.

In faith-based ("integrative") clinical psychology programs tenets of faith are integrated with the tenets nets of the field of psychology. Examples of the APA-Accredited Christian doctoral programs are Regent University, Biola University, Wheaton College, George Fox University, Azusa Pacific University, Seattle Pacific University and Fuller Theological Seminary. Sometimes this integration is even rooted in a very specific faith tradition such as at The Institute for the Psychological Sciences (IPS) in Arlington, Virginia. At IPS, clinical training and training in ethics takes place "in a manner consistent with the Catholic understanding of the person, marriage and family, as well as being equally consistent with the science of psychology" (Scrofani and Norcling, 2011, p. 121). In their article describing the clinical training at IPS the authors, both professors at IPS, go on to state that, "our identity as a Catholic institution is central to our mission..." (p. 121).

My experience in the higher education arena is that integrative models of education in the training of clinical psychologists, such as those programs listed above, raise concern as to how, in actuality, students from these programs are being trained. Specifically, are they being trained to impose their faith agenda on clients? Are they being trained only to work with clients who believe as they do? Ultimately, are they being trained to act ethically? Those of us who teach in integrative programs are used to these questions, and quite frequently find ourselves responding to these concerns both verbally, and as evidenced by this current discussion, in scholarship. Hathaway (2010) makes the point that a Christian who enters the profession of psychology voluntarily commits to upholding the tenets of the profession as defined by their professional colleagues. Hathaway goes on to state, "that Christian psychologists, resourced by the treasures of divine revelation and of the Christian faith, [should] be known for excellence in all they do" (p. 227). While acknowledging the repetitiveness of this task, hopefully these questions are engaged with grace and a thankful heart for the opportunity to dispel some persistent myths among those with little exposure to Christian integration.

In my many interactions with concerned colleagues on the subject of integration I have found that quick encounters addressing these questions do not result in any lasting schema change regarding what those from "religious schools" with their conservative agendas are "really up to." Typically, what is achieved is a kind of temporary relief on the part of these colleagues when they find out that faith-based programs must submit to the same American Psychological Association (APA) standards and rigor of accreditation that all accredited programs must meet. Also helpful for these colleagues to hear is that the practicum and internship sites where our students train are typically non-faith-based sites, with clients who may or may not express a religious belief system and who are varied across the spectrum of diversity; but alas, these colleagues remain skeptical. As one colleague put it, "I really don't believe that APA knows what you're up to."

In contrast to these brief encounters of ethical concerns, my experience has taught me that what is most effective in creating understanding of faith-based programs is dialogue, over time, with colleagues from secular programs with whom I have developed ongoing professional and personal relationships. This is not surprising, as it is in relationship that we have the opportunity to be truly known, and to appreciate our differences. Also helpful are the varied, long-standing relationships with training directors, both locally and across the country, with whom our students train. These directors often note how attuned and aware our students are to not impose their religious beliefs onto others. I would go so far as to say that students from faith-based programs might develop a hypersensitivity to any potential ethical situation that might raise a question about their motives. In fact, the concerns of some professionals may cause socially aware students of faith to deny their belief system in order to avoid stereotype threat. In other words, they may minimize their personal beliefs in order not to reinforce negative stereotypes about Christians among secular professionals.

In light of this hypersensitivity, the challenge then becomes how to affirm our students of faith and help them understand the role they play in addressing the health of all with whom they work, whether or not clients espouse a faith system. This includes educating students regarding the fact that everyone carries bias. There are ethical and unethical ways to integrate Christian ideals, or any other therapist ideals into the therapeutic relationship. In essence, how do we teach ethics from an integrative perspective? How do we affirm a student's faith and encourage a coalescence of their personal beliefs and professional practice? In the training of professional ethics, for the psychologist who is a Christian, I posit that similarities between biblical tenets and professional ethical tenets go beyond face validity and that acknowledgement of this fact serves the purpose of grounding the student in an amalgamated experience of their faith and ethical practice.

Professional Ethics and Biblical Tenets

One has only to read through the American Psychological Association's Ethical Principles of Psychologists and Code of Conduct (APA, 2010) to see how remarkably Christian beliefs and practices are mirrored in this secular document. For example, the Preamble to the ethics code states that work as a psychologist "requires a personal commitment and lifelong effort to act ethically; to encourage ethical behavior by students, supervisees, employees, and colleagues; and to consult with others concerning ethical problems" (p. 3). The Bible has similar exhortations. Hebrews 10:24 states, "And let us consider how to stir up one another to love and good works, not neglecting to meet together, as is the habit of some, but encouraging one another..." (English Standard Version).

Principle A--Beneficence and Nonmaleficence--urges psychologists to do no harm, while Principle B--Fidelity and Responsibility--calls psychologists to work well together and to be mindful of possible misuse of influence. Paul's letter to the churches around Ephesus makes similar points: "I therefore ... urge you to walk in a manner worthy of the calling to which you have been called, with all humility and gentleness, with patience, bearing with one another in love, eager to maintain the unity of the Spirit in the bond of peace" (Eph. 4:1-2, ESV).

Proverbs is a collection of Israelite wisdom literature, which reads like Principle D--Justice--and E--Respect for People's Rights and Dignity. Proverbs 31:9 states, "Open your mouth, judge righteously, defend the rights of the poor and needy" (ESV).

Ethical Standard 1.04 states, "when psychologists believe that there may have been an ethical violation by another psychologist, they attempt to resolve the issue by bringing it to the attention of that individual..." (APA, 2010, p.4). This directive is remarkably similar to Matthew 18:15, which states, "if your brother sins against you, go and tell him his fault, between you and him alone..."(ESV).

These references provide a few examples highlighting the commonalities of biblical teachings and the APA ethics code and are certainly not meant to be exhaustive. However, I do believe that understanding these commonalities is basic to teaching integration of faith and profession to the Christian psychologist in training, and they set the stage for the remainder of this discussion.

The expressed goal for this article set forth by the editors of this special edition is to present practical information that would help instructors teach integration effectively in their courses on ethics. Toward this goal I will suKest two pedagogical strategies important to the training of ethics in general, and how these strategies can be used in integrative programs, but first, some introductory comments.

Professional Ethics and Decision Making

Discussion of ethics theory and actual ethical decision-making models abound in psychology (Cottone & Claus, 2000; Forester-Miller & Davis, 1995; Hill, Glaser 8c Harden, 1998; Koocher 8c Keith-Spiegal, 2008; Pope 8c Vasquez, 2011; Sanders, 2013; Welfel 8c Kitchner, 1995), and are not unique to our field. For example, the fields of business (Bowie, 2013; Higgs, 1988), education (Narvaez, 2008; Narvaez, 2006), and law (D'Amato & Eberle, 2010) all contribute to this discourse. In my Ethics course I have found that incorporating general ideas or even specific rubrics from other fields into my teaching can enhance my clinical psychology students' understanding of their profession's ethical standards.

Each profession develops a set of guidelines or principles by which their organization determines appropriate practice. These principles are usually developed as living documents that are meant to be interactive with the professional's day-to-day life. Most codes, the APA's code being a prime example, and the code I will be referring to in this article, are developed with the understanding that just learning the code will not suffice. In psychological practice clinical judgment is assumed to be part of ethical decision making. In fact, modifiers (e.g, reasonably, appropriate) are provided throughout the APA ethics code as an acknowledgement that psychologists may find themselves in unique situations that require the clinical judgment of the clinician in order to navigate a thoughtful course of action. Whether as researchers, professors, supervisors, or psychotherapists, the APA ethics code provides a rubric commonly agreed upon by psychologists as the accepted standard of behavior. For the Christian clinician the question is raised: How does my faith (beliefs, understanding of God's teaching) interact with my professional code of ethics and ethical decision-making in the treatment of my clients? Thankfully, many authors have contributed to this dialogue.

Sanders (2013) has written extensively on the integration of professional ethics and faith, while McMinn and Campbell (2007), as well as others (Jones & But-man, 1991; Norcross & Goldfried, 2005; Richards and Bergin, 2005; Sperry and Shafranske, 2005), have provided us with models for integrative psychotherapy. In addition to integrative therapeutic models, psychologists of faith are uniquely equipped to engage Christian clients in the broader exploration of who the client is in Christ, and how in light of this the client makes meaning of their psychological symptoms and capacity for change.

So where do we begin in training student psychologists to think ethically about their work with clients? It begins with encouraging trainees to self-reflect on the roots of their ethical reasoning. To engage their biases and preconceived ideas about what health is and how people change.

Teaching Strategy #1: Inviting Students to Assess Their Ethical Decision-Making Heritage?

Training graduate students in professional ethics should "begin with the activation into awareness of each student's ethical/moral history, for it is on this scaffolding that all the training in theory and practical dilemmas will rest and on which all ethical decisions will be made" (Anderson, Scluieller, & Swenson, 2013, p. 485-486). To this end, the first project I assign in the graduate level ethics course I teach is that of the Ethics Genogram. The purpose of this assignment is grounded in the belief that students who are aware of how, and by whom, their moral and ethical decision-making was shaped can better understand how this history shapes their current ethical reasoning and decision making process. For this assignment students are asked to think about those who have influenced their moral/ethical development either overtly or covertly. Students may tend to focus on the positive modeling they have received and so I make it a point to ask them to also think about those who might have modeled how not to think or be. Students are then asked to take this information and create a "picture" of their ethical heritage. They can be as creative as they want as long as they include descriptors for each person depicted. At this point, I will give them some examples from my own ethical heritage (e.g., My mom modeled for me that to be in relationship with God meant prioritizing time with him. From this I learned that relationships need nurturing and commitment). Some students use a genogram structure similar to those found in Genograms: Assessment and Intervention (McGoldrick, Gerson, & Shellenberger, 1999), which I offer as one model for the assignment, while others might create paper trees, present photos with subtext, or color code icons on poster board. I am continually amazed at the talent students' display in the artwork produced for this assignment. The people most often depicted in these genograms are family members, friends, professors, and pastors, particularly youth pastors.

Approximately two weeks after the assignment is given, students bring their project to class where they break up into groups of three or four to share their Ethics Genogram with each other. Given the nature of the assignment students are often sharing new insights linked to personal information, so smaller groups allow for more comfortable sharing and more time to engage with each other's stories. After the small group sharing (approximately 20 minutes) students are invited to share their Ethics Genogram with the whole class, if they so choose. This sharing allows me to interact with a few students in front of the class and weave in ideas that I would like for the entire class to consider. An example of a comment I might make is, "from your descriptions it seems like there have been many people in your lifetime who taught you that doing the right thing, even when at a cost to yourself, is the best course of action," or "In looking at your picture I notice that the men in your family have been particularly influential on your development of ethical thinking."

On one level, this assignment is just fun. It pulls for creativity, community building through sharing, and laughter. On another level, this assignment raises personal awareness in ways that are unexpected and even profound. Each year students will share comments such as, "I never realized it before doing this assignment, but my Grandfather was very powerful in our family. In a positive way, his sense of right and wrong set the bar for the rest of us." Or, "I was shocked to find my baseball coach showing up in this assignment. It turns out that he had a big impact on me in terms of the importance of treating people with respect. Basically, he did this well, even with hostile and argumentative fellow coaches and parents, and I realized in doing this assignment how much my interactional style today has been shaped by watching him and hoping that I could emulate him somehow." Sometimes, the awareness is accompanied by sadness: "My uncle Bill taught me not to trust others. In working on this assignment I realized howl tend to be suspicious of other people's motives, rather than starting from a place of trust and openness." Or maybe the students gain a new perspective on their spiritual life, "Wow, I never realized that my view of God is so harsh. He is the rule maker, far removed and judgmental, whereas Jesus is the nurturer, someone I feel close to.. .1 really have to delve into this more." Integrative moments are in surplus as students begin to get a sense of how their faith, relationship with God, and relationships with others affect their worldview and shape their current personal and professional interactions. Ultimately:

  This exercise teaches students that they carry a heritage of
  decision-making within them. Beliefs and behaviors they observed,
  or that were tacitly passed down to them, may predispose them to
  view professional, ethical situations in a unique way. The project
  allows them to identify these influences, reflect on them, and
  understand their place in how the student approaches and chinks
  through ethical dilemmas in general. (Anderson et. al, 2013, p. 486)

At the end of class I collect all the assignments, read them, and then attach a sheet to each assignment with my comments, impressions, and any helpful connections, to be handed back at the next class meeting (I don't write directly on the assignment). I encourage students to put the assignment somewhere that they can access it again in a few years and add to or refine it. This way it can become a touchstone, so to speak, of those individuals and beliefs that are most influential to them. Particularly rewarding is that over the years alumni have occasionally reported back that they actually do take a look at their Ethical Genogram assignment now and again, and they make connections to how they tend to respond in certain situations.

Students typically react well to this assignment. They quickly connect the value of acknowledging where they come from, in terms of their ethical and moral reasoning, to how they might tend to approach professional ethical situations. In fact, some have shared their Ethics Genogram with their families or their own individual therapists in hopes of fostering their relationships and personal growth. Teaching students to attend to and understand their automatic, predisposed responses will make it much more likely that they will be self-reflective in a given ethical situation and less likely to respond from a place of rigidity.

I would caution instructors who utilize this type of assignment to provide advance notice to students that they will be sharing this assignment with fellow students in class, and with the instructor. Therefore, students can decide on what level of personal disclosure they feel comfortable with including in their descriptions. Also, I suggest structuring the general class sharing in such a way in which students are not allowed to over-share, creating the possibility that they might later feel uncomfortable or exposed in some way. (For a broader discussion of training graduate students in ethics, and of this assignment in particular, please see Anderson et al., 2013).

Training student clinicians to develop awareness of their own predispositions and potential biases is important. Also vital is encouraging discussion of the unique factors that come with being a psychologist of faith and working in the Christian sub-culture.

Understanding Ethical Decision-Making and the Christian Sub-Culture: How issues of faith show up in the therapeutic relationship.

In 2009, McMinn, Moon, and McCormick wrote an article entitled, Integration in the Classroom: Ten Teaching Strategies. In this article they briefly discuss the idea of "practical integration"; specifically, they explain how students in faith-based clinical psychology doctoral programs come into graduate school expecting their professors to provide them with clear answers to practical, integrative situations or questions, such as, "should I pray with my clients?" (p. 39). These authors go on to point out that, inevitably, students "feel disappointed--even disenchanted--when they discover wide-ranging opinions on issues of practical integration" (p. 39).

I believe it is no accident that McMinn, et al. chose ethical questions as stimuli for practical integrative conversations. In fact, it is difficult to think of another clinical or professional topic that pulls so strongly for direct answers. As novice students train to become licensed clinicians, the "dos ancl don'ts" are often the focus of attention. Understanding the "right" way to behave as a professional means protecting the license it took so long to obtain. Oftentimes, acknowledgment of the fact that becoming familiar with guidelines that govern our professional behavior is essential to good client care is a secondary concern.

Christian Psychologist or Psychologist who is a Christian?

In the doctoral ethics course that I teach (Rosemead School of Psychology, Biola University), I make a point to tell my students that the state of California does not license me as a Christian psychologist. I am licensed as a psychologist, and I am a Christian. Such a distinction might seem pedantic, however, I believe it is a fundamentally important distinction to make. This distinction can sometimes raise an alarm for students who specifically chose a faith-based graduate program in which to train where they can be "out" about their faith and learn how to integrate their religious belief system with psychological theory and practice. A question that some students raise is, "would it ever be appropriate to tell a client that he or she is beginning a relationship with a Christian psychologist?" Trainees can be heartened to learn that acknowledging the reality of licensing laws does not preclude a clinician of faith from stating that he or she is such or from utilizing activities relevant to a Christian client such as prayer journals and the use of scripture. Many authors have eloquently discussed this praxis (e.g., Jones and Butman, 2011; Sanders, 2013; Tan, 2007a; Walker, Gorsuch, & Tan, 2005; Walker, Gorsuch, Tan, 8c Otis, 2008). However, understanding how to ethically engage any client regarding factors that will affect their course of treatment is important.

The APA ethics code provides some helpful direction in answering the question of disclosure of faith to clients. Ethical Standard 10.01 (Informed Consent to Therapy) states that, "When obtaining informed consent to therapy as required in Standard 3.10, Informed Consent, psychologists inform clients/patients as early as is feasible in the therapeutic relationship about the nature [italics mine] 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..." (APA, 2010, p. 13). The issue is one of informed consent. If the Christian psychologist will overtly bring his or her faith into the room, then this self-disclosure should be made at the beginning of the treatment relationship when discussing the nature of therapy. I challenge trainees to think through their reasoning for any self-disclosure, which should always be to the benefit of the client. Therefore, the onus is on the trainee, in consultation with their supervisor, to determine the usefulness of this information to the client.

As a Christian psychologist I believe that Christ is in me and therefore in the room with me as I interact with clients. The question then is how will this belief manifest in the room, if at all. A question every clinician, regardless of his or her belief system, should be thoughtful about. Earlier in this article I discussed the importance of students' exploration into their own ethical development. This is crucial as gone are the days when therapists believed that they could interact with clients as a values-free blank slate. The reality is that our beliefs, worldviews, and experiences are ever present. In fact, I suggest that it is imperative to embrace this reality as it provides a context for relationship. My beliefs, worldview, and experiences interact with those of the person I am interacting with. This is a dynamic process of shared reality. The choice for the Christian psychologist is to determine if the shared reality should, through self-disclosure, be centered on a common faith. How, then, does this self-disclosure help or become a detriment to the client?

And what of the non-Christian clients we work with? What if this client talks of a longing to be loved and accepted? Some Christian trainees may feel that to deny the client an opportunity to come to know Christ, the ultimate healer and savior, would make them derelict in their calling as a Christian. Yet, for the trainee to do so would be to step out of their role as a psychologist in training (Fisher, 2013; Plante, 2007; Richards & Bergin, 2005). I suggest that if God's desire is to call someone to him, what a Christian psychologist can offer to the client is treatment of the presenting problem and psychological issues that then make it possible for the client to engage in healthier relationships. This work alone is valuable, but would also then make it possible for the client to enter into a relationship with God. In this scenario the psychologist's role is important in creating fertile ground for a future seed of spiritual growth, not to sow the seed. For a Christian psychologist to assume that he or she is the only one to lead a non-believing client to the Lord seems to deny the very power of the deity in question.

If God called me to this profession, then why would he set me up to lose my license by acting in an unethical manner with my client? This discussion is similar to a question that comes up when talking about sexual feelings in psychotherapy--"what if God brings the love of my life through my door as a client?" As a Christian, I find it hard to believe that God would divinely ordain this encounter. In fact, I would go so far as to suggest that this scenario would be evidence (if the ethics code wasn't enough) that I had better become much more introspective about my personal motives and how they might drive my theology.

How do we help our students in integrative programs think through various ethical scenarios in a way that addresses these questions adequately? Educating students on the purpose of their professional ethics code and requiring them to be savvy with appropriate application of the ethical standards is just a starting point, but an important one that requires practice.

Teaching Strategy #2: Creative Use of Vignettes

The use of vignettes is a common strategy employed in the teaching of ethics.

  There is a necessary practice component to teaching ethical
  decision-making that allows students to "try on" various
  responses and discuss the likely outcomes. The use of case
  vignettes in presenting various ethical dilemmas, with ample
  time for discussion, is a useful tool. To begin with a
  particular scenario and then change the facts, places,
  timeframes is one method that seems particularly effective.
  Not only does it hone the student's knowledge base in a given
  area, it teaches flexibility in thinking that more accurately
  mirrors what is expected in the real-world clinical experiences
  students will face. (Anderson, et. al., p. 488)

In my course on professional ethics I start students working with vignettes in small groups and in the class at large using an if-then technique. My goal is that students will be able to adapt to new details in the scenario and learn to deftly adjust their thinking and course of action. Over time, I add to these two strategies vignettes assigned as homework, which the students complete independently. The vignettes become increasing more complicated over the semester in terms of the number of ethical/professional issues and legal ramifications that are present in each vignette. By the end of the semester a single vignette typically introduces at least eight to ten ethical considerations.

The rubric I ask the students to use when responding to vignettes is the following:

1. Identify who the client is.

2. Identify what client characteristics are salient (e.g., age, ethnicity, gender, religion, etc.).

3. Identify your role (e.g., individual therapist, family therapist, evaluator, etc.).

4. Identify the context (e.g., private practice, clinic, and organization).

5. Identify the ethical dilemma(s).

6. Identify the ethical standards that apply.

7. Identify any legal or risk assessment issues.

8. What is your best course of action, if any?

For the purpose of this discussion, I would like to highlight how important cultural factors are in the assessment of an ethical dilemma. In any culture one will find expectations, cultural norms, and tacit rules about interpersonal engagement that exist within the culture. The Christian sub-culture is no different. In the Christian tradition believers are considered brothers and sisters in Christ; called to uplift and support one another, as well as to pursue a relationship with God through his word and in community with other believers. Assumptions made on the part of clients who come from the same, or similar, faith traditions as the treating psychologist can sometimes create ethical dilemmas unique to this pairing. Even more so psychology trainees can find themselves faced with these difficult dilemmas when working with clients of faith, given that these psychologists-in-training are in the process of learning psychological theory and practice, delving into their own beliefs, all while working with clients who might make assumptions about them based on a shared faith system.

The following is an example of how an ethical dilemma may arise in the therapeutic relationship when a Christian client chooses a therapist because he or she is also a Christian:

  John is a 22 year-old Caucasian man referred to a psychology
  trainee by his roommate's sister, Megan. John and Megan were
  at a barbecue together where John shared with Megan his desire
  to get into therapy, and also shared his concern that it be with
  someone who, "won't think I'm crazy just because I believe in God."

  Megan then mentioned to John that she knew of a therapist who is
  a Christian and that she had heard good things about him from her
  former Resident Assistant. Megan remembered the last name of the
  therapist in training, Douglas, and John was able to track down the
  therapist at the local university clinic. John and Brian Douglas, a
  26 year-old Caucasian male, began a therapeutic relationship a few
  weeks later.

  In the first few sessions John made several statements such as,
  "Well, you know what it's like" when referring to his interactions
  with non-Christians.Brian was unsure what John meant, but originally
  thought these comments were an attempt on John's part to bond with
  Brian. Brian was also aware that they were both Caucasian and of
  simlar age, factors which could also create a sense of mutual
  accord. In early sessions Brian was focused on developing rapport
  with John and so didn't ask John to elaborate on these statements,
  for fear of seeming confrontational. However, Brian became more
  concerned with these statements over time especially as John made
  other comments reflective of his assumption that he and John held
  the same beliefs and opinions on just about every subject. John had
  also started asking Brian to open each therapy session in prayer.
  Still other comments made by John led Brian to develop a growing
  concern about what seemed like John's use of his religious beliefs
  to defend against feelings of worthlessness, and his presentation
  of very rigid beliefs across environments and in John's
  relationships. About six weeks into therapy Brian decided to
  gently bring these observations up to John. John reacted with
  dismay, hurt, and then anger stating, "I thought of all people
  you, as a Christian, would understand me." John left the session
  early and did not return.

At the end of the vignette I ask students to follow the rubric ending in a course of action. I also spend time in class asking students about the cultural elements present in the case and whether or not they would have handled the case any differently. The situation with Brian and John is likely upsetting to both seasoned clinician and trainee alike. I have noted that this vignette, and others like it, tends to pull for feelings of guilt in students of faith. Trainee's wonder if they over reacted to John, misread his rigidity, and ultimately let him (and God) down. This situation can predispose a student to avoiding difficult dialogue with his or her client in future, even at the expense of good intervention. Being part of the Christian community, which believes in grace and truth yet sometimes has difficulty with these co-existing, can contribute to a lack of appropriate confrontation of religious defenses (Narramore, 1994).

As stated earlier, changing details in the vignette allows students to engage it from a different vantage point and become more flexible and nimble with clinical/ethical decision-making. It also allows for even more practice in applying the ethics code in varying situations, which is something many authors have suggested needs to increase in ethics training of graduate students (Anderson et al., 2013; Callan & Callan, 2005; Knapp & VandeCreek, 2003; McMinn & Meek, 1997; Nagy,.2005, 2011).

In the case of John, what if John was sixteen and female, or Asian American instead of Caucasian? After each change in the same vignette, students are then given time to revisit the rubric and develop a possibly new course of action. When this type of exercise takes place in the classroom setting, students tend to become more comfortable consulting with one another as they fire thoughts back and forth to each other. At this point the instructor is guiding the process, watching for opportunities to redirect or correct, but not leading the discussion. Other useful vignettes I have used specific to working with clients of faith include: working with a Christian couple who are, by self-report, staying in their marriage only because of their religious beliefs, but whose children are suffering the consequences of the broken marriage; working with a Christian client who expects the Christian psychologist to socialize with him given that they are brothers and sisters in Christ; working with a client who self-identifies as a "Reincarnationist" and whose relational pattern is to abruptly end relationships and move on to a new address and phone number. In this last example, the focus here is not on her identified spiritual belief, but on how this belief has become a convenient way to avoid working through difficult situations/feelings in her relationships because, as she explains, I can "do it over in the next life."

A final suxestion regarding vignettes is to have each student write vignettes at regular intervals throughout their course on ethics. The old adage applies here--you never learn a subject as well as when you have to teach it. I ask students to write vignettes complete with details and a plan of action at least four times during the semester course. The first vignette is not graded, but may be used in discussion with the entire class. The next three are graded for thoroughness and accuracy, and students share these in small groups for feedback. I also pull from these vignettes for future exams. What I have found is that students are typically very thorough and careful about including all the ethical standards, and legal and professional issues that could apply. They also become increasingly comfortable with developing a course of action that they may need to "defend" to the entire class or small group, and not just to the instructor. This exercise allows students to develop ownership of the ethical decision-making process that serves to build their confidence level in this important clinical practice area.

Students tend to find the use of vignettes a bit intimidating at first. However, as they progress in their knowledge of professional ethics, and continue to practice applying these principles both in and out of class time, they come to enjoy this tool. The creation of their own vignettes moves them to another level of mastery in the application of the ethics code. Also valuable for the student of faith is the opportunity to wrestle with issues common to those who are integrating faith and profession and working with clients of faith. Vignettes geared toward these issues provide needed practice for students, who will, possibly from their very first training opportunity, wrestle with issues of integration in their clinical work.

Lastly, I would like to briefly discuss the importance of modeling ethical and clinical decision-making for students. Modeling is a teaching strategy that is very effective and should not be underestimated. My students have often commented on the value of hearing my stories complete with all the affect attached. Modeling for them what I have learned and would do again, and where I have made poor decisions, and hopefully learned from them, is what seems to stick with students the most. Letting them in on my struggle over ethical and moral issues somehow makes the process they go through a bit more doable. For example, sharing heart-wrenching situations, that to this day are still painful to me, such as having a child client that I had worked with for over a year pulled from therapy by a guardian who was angry about custody arrangements, resulting in no chance of closure for me or the child. Sharing this story, and others, allows for modeling of how to handle the affect that accompanies our decision-making and how emotion might begin to lead our decision-making process. Do I browbeat the guardian into allowing a termination session after a clinical rationale has been made for the importance of a last session, and the guardian still declines? Would that be best for the child or has it become about me?

In meeting with alumni years after they took my ethics course, these former students will bring up a story from the class and talk about it as being an important touchstone for them currently. Modeling my struggles of what to do in a given situation was what stuck with them over the years. Furthermore, the power of modeling, particularly in modeling integration for students in faith-based programs, has been well researched. Randall Sorenson had a particular interest in this area, and in his 1997 study he found that professors who were open with students about there spiritual development, including their struggles, were particularly impactful in shaping the integration perspective for doctoral-level clinical psychology students at Christian universities.

Conclusion

My hope is that what has been offered here are pragmatic tools for those faculty who seek to train students to think ethically, grow in their discernment, and understand that the nuanced process of ethical decision making, especially in regards to the students' integration of faith and practice, is something that students will engage in throughout their careers. Teaching strategies such as inviting students to see the need for, and to engage in, their own self-reflection regarding their ethical decision-making heritage, and working creatively with vignettes are ways to foster growth.

In my sixteen-plus years of teaching professional ethics, and in my service on a state ethics committee, I have found that rarely does an ethical situation stay with the obvious. And rather than lamenting this fact, I suggest that embracing it is exactly what makes teaching professional ethics fun! Pragmatically speaking, I would like to see more scholarship dedicated to the integrative issues that can arise in working with clients of faith, as well as for the Christian psychologist working both with Christian and non-Christian clientele.

Resources

In addition to the references cites, for further information on training ethics from an integrative perspective, anything by Randolph K. Sanders, Richard E. Burman, Alan C. Tjeltveit, and Brad Johnson would be helpful in terms of practical ethics. Also, an interesting philosophical debate on the foundation of professional ethics between William L. Hathaway and A. C. Tjeltveit (Journal of Psychology and Theology, Fall 2001, Vol. 29) is well worth your time. I also suKest, if possible, attending the annual APA conference presentations by the APA ethics committee and reading the ethics section of the APA monitor.

References

American Psychological Association. (2010). Ethical principles of psychologists and code of conduct. Retrieved from www.apa.org/ethics/code/index/.aspx.

Anderson, T. L., Schneller, G. R., & Swenson, J (2013). Training programs. In Sanders, R. K. (Ed.), Christian counseling ethics: A handbook for psychologists, therapists & pastors (pp. 482-505). Downers Grove, IL: Inrervarsity Press.

Bowie, N. E. (2013). Business ethics and the 21" centug. Manhattan, NY: Springer.

Callan, J., & Callan, M. (2005). An historic overview of basic approaches and issues in ethical and moral philosophy and principles: A foundation for understanding ethics in psychology. In S. Bucky, J. Callan, & G. S tricker (Eds.), Ethical and legal issues for mental health professionals (pp. 11-26). Binghamton, NY: The Haworth Maltreatment & Trauma Press.

Cottone, R. R., 8c Claus, R. E. (2000). Ethical decision-making models: A review of the literature. Journal of Counseling and Development, 78, 275-283.

D'Amato, A., & Eberle, E. J. (2010). Three Models of Legal Ethics. Faculty Working Papers: Paper73, Retrieved from http://scholarlycommons.law.northwestern.edu/facultyworkingpapers/73

Fisher, C. B. (2013). Decoding the ethics code: A practical guide for psychologists. Los Angeles, CA: SAGE Publications, Inc.

Forester-Miller, H., & Davis, T. E. (1995). A practitioner's guide to ethical decision-making. Annapolis Junction, MD: American Counseling Association.

Hathaway, W. L. (2010). Faithful skepticism/curious faith. in G. L. Moriarty, (Ed.), Integratingfaith and psychology: Twelve psychologists tell their stories. Downers Grove, IL: Intervarsity Press.

Higgs, L. (1988, June). The reaching of business ethics and social values in the S. D. A. college business curriculum: A conceptual model. Institute for Christian college teaching. Presentation conducted at Union College, Schenectady, New York.

Hill, M., Glaser, K., 8c Harden, J. (1998). A feminist model for ethical decision making. Women er Therapy, 21(3),101-121.

Jones, S. L., & Burman, R. E. (1991). Modern psychotherapies: A comprehensive Christian appraisal. Downers Grove, IL: Intervarsity Press.

Jones, S. L., & Burman, R. E. (2011). Modern psychotherapies: A comprehensive Christian appraisal (2nd ed.). Downers Grove, IL: Inter-varsity Press.

Knapp, S., & VanderCreek, L. (2003). Legal and ethical issues in billing patients and collecting fees. Psychotherapy: Theory, Research, Practice, Training, 30,25-31.

Koochcr, G. P., 8c Keith-Spiegel, P. (2008). Ethics in psychology and the mental health professions: Standards and cases (3[rd] ed.). New York, NY: Oxford University Press.

McGoldrick, M., Gerson, R., 8c Shellenberger, S. (1999). Genograms: Assessment and intervention. New York, NY: W. W. Norton & Company.

McMinn, M. R., & Campbell, C. D. (2007). Integrative psychotherapy: Toward a comprehensive Christian approach. Downers Grove, IL: Intervarsity Press.

McMinn, M. R., & Meek, K. R. (1997). Training programs. In R. K. Sanders (Ed.), Christian counseling ethics: A handbook for therapists, pastors; and counselors (pp. 277-296). Downers Grove, IL: Intervarsity Press.

McMinn, M. R., Moon, G. W., & McCormick, A. G. (2009). Integration in the classroom: Ten teaching strategies.JourmiloPsychology and Theology, 37(1), 39-47.

Nagy, T. F. (2005). Ethics in plain English: An illustrative casebook for psychologists. Washington, DC: American Psychological Association.

Nagy, T. F. (2011). Essential ethics for psychologists: A primer for understanding and mastering core issues. Washington DC: American Psychological Association.

Narramore, B. (1994). Dealing with Religious Resistances in Therapy. Journal of Psychology and Theology. 22, 249-258.

Narvaez, D. (2006). Integrative Ethical Education. In M. Killen & J. Smetana (Eds.), Handbook of Moral Development (pp. 703-733). Mahwah, NJ: Erlbaum.

Narvaez, D. (2008). Integrative Ethical Education. Moral Psychology Laboratory. Guidebook, Version 2.1. University of Notre Dame.

Norcross, J. C., 8c Goldfried, M. R. (2005). Handbook of psychotherapy integration (2[nd] ed.). New York, NY: Oxford University Press.

Plante, T. G. (2007). Integrating spirituality and psychotherapy: Ethical issues and principles to consider. Journal of Clinical Psychology, 63,891-902.

Pope, K. S., & Vasquez, M. J. T. (2011). Ethics in psychotherapy and counseling (4[th] ed.). New York, NY: Wiley.

Richards, P. S., & Bergin, A. E. (2005). A spiritual strategy for counseling and psychotherapy (2nd ed.). Washington, DC: American Psychological Association.

Sanders, R. K. (Ed.) (2013). Christian Counseling Ethics: A handbook for psychologists, therapists, and pastors (2nd ed.). Downers Grove, IL: Intervarsity Press.

Sanders, R. K. (2013). A model fir ethical decision making In R. K. Sanders (Ed.) Christian counseling ethics: A handbook for psychologists, therapists & pastors (pp. 50-525). Downers Grove, IL: Intervarsity Press.

Scrofani, P., & Nordling. W. (2011). The institute for the psychological sciences: An integrative Catholic approach to clinical training. Journal of Psychology and Christianity, 30, 121-127.

Sorenson, R. L. (1997). Doctoral student's integration of psychology and Christianity: Perspectives via attachment theory and multidimensional scaling. Journal for the Scientific Study of Religion, 36, 530-548.

Sperry L., & Shafranske, E. P. (Eds.) (2005). Spiritually oriented psychotherapy. Washington, DC: American Psychological Association.

Tan, S.-Y. (2007a). Use of prayer and scripture in cognitive-behavioral therapy.Journal of Psychology and Christianity, 26,101-111.

Walker, D. F., Gorsuch, R. L., & Tan, S.-Y. (2005). Therapists' use of religious and spiritual interventions in Christian counseling: A preliminary report. Counseling and Values, 49, 107-119.

Walker, D. F., Gorsuch, R. L., & Tan, S.-Y., & Otis, K. E. (2008). Use of religious and spiritual interventions by trainees in APA-accredited Christian clinical programs. Mental Health, Religion & Culture, 11,623-633.

Welfel, E. R., & Kitchener, K. S. (1995). Introduction to the special section: Ethics education-an agenda for the '90s. In D. N. Bcrsoff (Ed.), Ethical conflicts in psychology. Washington, DC: American Psychological Association.

Tamara L. Anderson Blob University

Correspondence concerning this article should be addressed to Tamara L. Anderson Rosemead School of Psychology, Biola University, 13800 Biota Ave., La Mirada, CA 90639. Email: tamara.anderson@biola.edu

Author Information

ANDERSON, TAMARA L. Address: Rosemead School of Psychology, Biola University, 13800 Biola Ave., La Mirada, CA 90639. Email: tamara.anderson@biola.edu. Degrees: B.A. (Psychology) Biola University; M.A. (Clinical Psychology) Pepperdinc University; Ph.D.--Californian School of Professional Psychology Los Angeles. Specializations: Ethics for psychologists, gender issues, and family-work issues.