Canadian Psychological Association Research Articles

Ethical Dilemmas Faced by Correctional Psychologists in Canada

There are numerous ethical issues that correctional psychologists in Canada face on a regular basis. This article analyzes the following ethical issues as they relate to the adult correctional context in Canada: (a) who is the client, (b) confidentiality, (c) protection of psychological records, (d) informed consent, (e) assessment, (f) corroboration, (g) refusal of services, (h) nondiscrimination, (i) competence, (j) knowledge of legal structure, (k) accuracy and honesty, (l) misuses of psychological information, and (m) multiple relationships. This article is organized around three of the four principles of the Canadian Psychological Association's ethics guide.

Editorial

Editorial

Cognitive Deficits in Children with Attention Deficit Hyperactivity Disorder: A Long-Term Follow-Up.

Abstract The phrase long-term follow-up in the title of this paper refers to my Presidential Address to CPA (Douglas, 1972), in which I made my first attempt to pull together my on the nature of the cognitive deficits associated with Childhood Hyperactivity, now known as Attention Deficit Hyperactivity Disorder. This paper represents a much later attempt to my thinking. The paper describes my current conceptualization of the cognitive and motor deficits of children with ADHD. It points to the self-regulatory nature of their deficits, and stresses the importance of differentiating between the attentional and inhibitory components, as opposed to the strategic or organizational components, of self-regulation. A main theme is the need for better collaboration among investigators to develop a diagnostic profile of operationally defined, laboratory-based measures that can assess specific attentional, inhibitory, and strategic deficits under clearly specified conditions. I argue that the profile should also include measures and manipulations that demonstrate the cognitive strengths of ADHD children, which are frequently masked by impaired self-regulation. I discuss the possibility of using tasks and games based on the operational definitions to try to influence the early development of cognitive and motor control processes in ADHD. I also argue that pervasive, dose-dependent stimulant effects across multiple simple and complex tasks point to action on self-regulatory processes and provide one example showing that high doses can produce overregulation. I am very grateful to have been honoured with the Lifetime Contributions award from the Canadian Psychological Association, and for the invitation to use this occasion to my thinking on the cognitive and motor deficits associated with Attention Deficit Hyperactivity Disorder (ADHD), a topic that has consumed my interest for many years. It is particularly appropriate that this event is taking place at the Annual Meeting of CPA in St. John's, Newfoundland. Some years ago, when I was President of CPA, I gave my Presidential Address at the Annual Meeting, which also was held in St. John's that year. I developed a deep affection for the town, and it is a great pleasure to be back. As you may have guessed, the talk dealt with ADHD, then known as Childhood Hyperactivity. The topic was Stop, Look, and Listen: The Problem of Sustained Attention and Impulse Control in Hyperactive and Normal Children (Douglas, 1972). Thus, you can consider this talk a long-term follow-up. Since that time, the field has experienced a mind-boggling surge of research. Theories and models attempting to establish the basic nature of the disorder have proliferated; the debate about diagnostic and treatment approaches has taken many turns; and neuroscience advances in brain imaging and the neurotransmitters have begun to show an impact. As new evidence and new theories have emerged, those of us working in the field have had to continually update our thinking. I will use this talk to give you a brief overview of my current conceptualization of the cognitive and motor deficits associated with ADHD, highlighting the research that has guided my thinking, and pointing to possible diagnostic and treatment implications. Search for the Core Deficit Attempts to characterize the cognitive deficits of children with ADHD have emphasized several key processes, including attention, inhibition, state regulation, delay aversion, and executive functions. Considerable confusion has developed, however, because investigators have differed in the priority they assign to each of these processes, arid in how they conceptualize the relationships among them. In the model proposed by Barkley (1997), a core inhibitory deficit impairs the development of several executive functions, including working memory. In contrast, Denney and Rapport (2001) proposed a model in which working memory constitutes the key causal process. …

Address by H. E. Dr. Vaira Vike-Freiberga, President of Latvia, at the 65th Congress of the Canadian Psychological Association.

Address by H. E. Dr. Vaira Vike-Freiberga, President of Latvia, at the 65th Congress of the Canadian Psychological Association.

A Survey of Hospital Psychology in Canada.

Abstract Despite the major advances in health psychology over the past decade and the changes that have taken place in the Canadian health sector, there remains a paucity of information available about the structure of psychological services in Canadian health-care settings. The most current information about psychology in Canada's hospitals was gathered in 1982 - almost 20 years ago (Arnett, Martin, Steiner, & Goodman, 1987). This article updates the previous information, as it presents the results of a survey that was sent to 975 acute, psychiatric and continuing care health facilities with a minimum patient bed count of 100. Detailed information about the number of psychologists and administrative organizations of psychological services in Canada are reported. The range of services provided by psychologists in health-care settings has expanded, and professional autonomy, as shown by the existence of independent departments of psychology, has changed. The implications of these results for the organization and delivery of psychological services in Canadian healthcare, and for advocacy on the part of psychology, are provided. Over a decade ago, Arnett and colleagues conducted a survey of Canadian hospital psychology (Arnett, Martin, Steiner, & Goodman, 1987). Since that time, the role and responsibilities of psychologists in healthcare settings have developed and expanded, and health psychology continues to play a prominent role in health-care systems across Canada. Hearn and Evans (1993) estimated that 17% of registered psychologists are associated with health-care facilities in Canada. Hospital-based psychologists have a prominent role in mental health-care provision and have an increasing role in the realm of general healthcare (Dunn, 1986), even while clinical psychologists have adopted a broader vision of health (Arnett, 2001). It has further been suggested that the potential for clinical psychologists as important contributors to healthcare services outside the area of mental health should be acknowledged and would allow for more public access to potentially beneficial psychological services and academic initiatives (Arnett, 2001; Canadian Psychological Association, 1999). This vision, while admittedly broader than just involving psychologists in hospital settings, would involve more training for graduate students in the area of medical health early on in their graduate experiences to prepare them more fully for predoctoral internship. As the duties of hospital psychologists have expanded, there has also been more movement into disciplines traditionally subsumed by other health professionals (cf. Dunn, 1986). In the previous Canadian survey, Arnett et al. (1987) determined that while psychologists were taking on more active roles in a variety of health-care areas, the predominant influence of physicians was still a major factor in defining those roles. In addition, psychology played only a minor role in administration. For example, few psychologists had voting privileges in medical boards. However, there are many activities in which a psychologist can be involved. Dunn (1986) indicates that in order to fully utilize their training and skills, hospital-based psychologists often try to create a multifaceted professional role (e.g., consultation, teaching, research) with multiple levels of impact (patient, provider, system). Goodman (2000) advocated for a direct access model of psychology (i.e., autonomous psychology departments). he suggests that psychologists have secured positions in hospitals and health-care institutions, but have often lost the administrative structures and supports necessary to carry out all aspects of the professional role (i.e., psychological services, teaching and research). Hearn and Evans (1993) identified a number of developments that have occurred since the publication of the last Canadian survey (Arnett et al., 1987) that have affected the practice of health psychologists. …

Diversity Training in Canadian Predoctoral Clinical Psychology Internships: A Survey of Directors of Internship Training.

Abstract A survey of diversity training in Canadian Clinical Psychology predoctoral internships was conducted to examine how this complex issue is approached in internship training and also, as a follow-up to a previous survey of doctoral program directors completed by Hertzsprung and Dobson (2000). The training directors of internships listed in the Canadian Council of Professional Psychology Programs were asked to complete a survey that evaluated the use and perceived effectiveness of diversity training methods. The training directors varied in how important and effective they perceived these different training methods, although the majority of the training directors believed that interns complete internship programs with sufficient training in diversity for their roles as clinical psychologists. Internship directors also rated the 2002 Canadian Psychological Association internship accreditation criteria in terms of the level of prescription for diversity training at accredited sites. The implications of these results for future research and training are discussed. Canada is considered a diverse society, consisting of people with diverse ethnicities, religions, and languages (Kazarian & Evans, 1996). According to the most recent Canadian Census in 2001 (Statistics Canada, 2001), 13% of the Canadian population identify themselves as a visible minority and 48% of the Canadian population defines their ethnic origin as non-British or non-French. Given these observations, Canadian psychologists are likely to encounter individuals from diverse backgrounds seeking mental health services. It can be argued that clinical competency includes knowledge about diversity issues, and an awareness of the role of unique experiences on clients' mental health (Sue, Bingham, Porche-Burke, & Vasquez, 1999). Clinicians and researchers in clinical psychology have become increasingly aware of the role of diversity factors, such as ethnic background, gender, and sexual orientation in personality development and functioning (Fuertes, Bartolomeo, & Nichols, 2001; Sue et al., 1999) and the potentially moderating role of diversity in mental disorders (cf., Bjorck, Lee, & Cohen, 1997). Although the influence of diversity in one's mental health is an important area to examine, a review of the literature is beyond the scope of this brief report. Psychologists are also enjoined to attend to diversity considerations from an ethical perspective. The Canadian Psychological Association (CPA) includes references to diversity in the Canadian Code of Ethics for Psychologists (CPA, 2000). The first two principles of the Code of Ethics (Respect for the Dignity of Persons and Responsible Caring) direct psychologists to treat all individuals as of equal status and worth, and not to discriminate on the basis of a number of diversity factors (e.g., race, religion, sexual preference). The Code of Ethics strives to ensure that the most vulnerable persons in Canada are protected and their rights are observed in psychologists' ethical decision-making. Psychologists who are responsible for designing training programs need to ensure that their programs encourage trainees to contribute to the fair distribution of benefits to individuals and groups, and ensure programs do not unfairly exclude those who are vulnerable or may be disadvantaged in any way (CPA, 2000). Competency in diversity issues can be established during graduate training. Hertzsprung and Dobson (2000) investigated the status of diversity training in the clinical psychology graduate programs across Canada by surveying the directors of training. They found that the directors rated colloquia and workshops as more effective than other methods for training in diversity. They generally supported the integration of content related to diversity into core coursework, and rated learning through in vivo exposure and practicum experience as effective ways to encourage diversity competency. …

The Economic Burden of Anxiety Disorders in Canada.

Abstract Concern over the costs of medical conditions has traditionally overshadowed interest in assessing the costs of mental health problems. Recent research, however, indicates that mental disorders impose considerable costs on society and on the sufferer. Most of this research comes from the United States, while little is known about health-care use patterns, impairment, and costs associated with psychological problems in Given that cost containment has become a priority, it is crucial to examine mental disorders that may exert pressure on Canada's health-care system. Among mental health problems, anxiety disorders have received considerable attention, as they have been shown to be costly. Among the anxiety disorders, generalized anxiety disorder deserves closer examination as it is highly prevalent in the community and in the general medical sector, and has been shown to be disabling, which suggests that this disorder is a potential cost driver. The restructuring of the Canadian health-care system has clearly been a major topic of concern for health planners, policymakers, administrators, providers, and the public alike, particularly in the last few years. Costs have been the key matter at hand and specific issues that have prompted the re-evaluation of the organization of our health-care system have included access to health-care providers, rising drug costs, wait-lists for tests and treatments, and privatization. Similar to countries worldwide, Canada has been striving for cost containment, as approximately onethird of all provincial budgets are spent solely on the provision of health care (Hunsley, 2003). In an effort to address these concerns, between April 2001 and November 2002, the Commission on the Future of Health Care in Canada (CFHCC) implemented a nationwide examination of the Canadian health-care system, and as part of its inquiry, the Commission vigorously solicited input and proposals for areas of improvement from Canadian citizens and individuals working in all fields of health, including mental health. Although the Canadian Psychological Association's (CPA) work in the CFHCC inquiry is considered by far to be the most significant advocacy effort Canadian psychology has engaged in, the extent of this effort is not entirely evident upon examination of the recommendations put forth in the final report. It seems that increasing access to mental health services is not among the top priorities of health-care planners, providers, and consumers at this time, as it was barely mentioned (except within the context of the provision of home-care services). In its analysis of the Commission's final report, the CPA alluded to the fact that the recommendations are a reflection of the model on which our health-care system is based - one that defines health as physical, despite the fact that health (as per the World Health Organization definition), is a state of complete physical, mental, and social well-being. Essentially, the report did not put human behaviour at the heart of health care in Canada. The argument has commonly been made that mental health does not yet figure equally into this fragmented health-care system, despite the plethora of scientific evidence showing that physical and mental health are intimately and inextricably intertwined (Allon & Service, 1999). Having said this, Canadian psychologists are now in a position, perhaps more than ever, to substantiate this long-standing assertion. Although the CPA and provincial psychological regulatory bodies did present extensive data to the Commission demonstrating the relationship between mental and physical health, as well as the costs associated with psychological disorders, this evidence was derived for the most part from research conducted in the United States and was then used to draw inferences about the Canadian health-care system. Although it has been the case that there have been few Canadian data to rely on, it clearly has become inadequate to rely on U. …

The Prescription Privilege Debate in Canada: The Voices of Today's and Tomorrow's Psychologists.

Abstract Canadian psychology professionals (n = 591) and psychology students (n = 272) were asked for their opinions about prescription privileges for psychologists. A majority of respondents indicated that properly trained psychologists should be allowed to prescribe, and that the Canadian Psychological Association (CPA) should advocate for such privileges. Few people felt that prescribing was theoretically or philosophically opposed to the field of psychology or that it would compromise psychological service delivery. Not surprisingly, clinical students were more likely than other psychology graduate students to indicate that they would seek prescription privileges if these were available. The prescription privilege debate in Canada has generated a surfeit of arguments for, and against, the movement. The debate has considered both the heritage of psychology and the future of psychology. The debate has also considered topics such as liability, professional competency, and ethical issues (e.g., Dozois & Dobson, 1995a, b; Hayes, Walser, & Follette, 1995; McCrea, Enman, & Pettifor, 1997; Pagliaro, 1995). It has even been questioned whether or not psychologists want prescription privileges in the first place (Dobson & Dozois, 2001). Glenn D. Walters (2001) discussed his meta-analysis of survey data on the issue of prescription privileges. He sampled 16 studies that tapped into the attitudes of psychological professionals as well as students. Walters found that respondents agreed that properly trained psychologists should be allowed to prescribe medication, a view that was especially strong among graduate students. Graduate students were also more likely than practicing psychologists to express an interest in seeking prescription privileges. Moreover, Walters found no clear consensus on a question of whether the American Psychological Association (APA) should advocate for prescription privileges. When the attitudes of practicing psychologists and graduate students were considered together, support for APA advocacy was close to evenly split. Graduate students, when considered separately, supported APA advocacy for prescription privileges. Walters articulated the possibility that medical professionals would train prescribing psychologists, a circumstance that he felt would open psychology up to assimilation by the medical field. He also expressed concern that psychologists, burdened with the required training to competently prescribe medications, would fail to develop and maintain expertise in the practice of psychotherapy. Nonetheless, according to the APA, jurisdictions in the United States have moved forward with the granting of prescription privileges to psychologists. For example, Louisiana recently became the second state in that country to gain a law authorizing properly trained psychologists to prescribe certain medications for the treatment of mental disorders. New Mexico enacted such legislation in 2002 (Daw, 2002). Canadians have also participated in this debate (e.g., Dobson & Dozois, 2001; Nussbaum, 2001). Specifically, Nussbaum debated some of Walters' (2001) conclusions. For example, Walters' meta-analysis led to the conclusion that a majority of students, but roughly half of practicing psychologists, were interested in seeking prescription privileges. Walters interpreted these finding as indicating a more general attitude of nonpursuit and nonsupport among practicing psychologists. Nussbaum argued that support from nearly half of practicing psychologists, while not a majority, was noteworthy. Moreover, Nussbaum argued that it should not be construed that practicing psychologists are unmotivated to seek prescription privileges. Instead, he proposed that many older more established psychologists might be less likely to pursue prescription privileges because they feel that the effort would provide little reward to them at mid-career. Nussbaum argued that while these professionals may not desire the privilege for themselves, they might recognize that prescription privileges could afford some advantage to their young students. …

The Costs of Anxiety Disorders and their Treatment: A Commentary.

Abstract aim of this article is to comment on two review papers (Koemer et al., 2004 and Roberge et al., 2004): one examining the economic burden of anxiety disorders, and the other the economic benefit of cognitive behaviour therapy for anxiety disorder. It is evident from both these papers that Canadian data on the direct and indirect costs of treating and not treating anxiety disorders are lacking and sorely needed, in addition to demonstrating the importance of addressing cost-related isues in Canadian mental health research, the authors of these papers present basic concepts of economic evaluation. They also identify the areas more in need of cost analysis and discuss the implications of the Canadian findings for health-care policy and research in Canada. Overall, the two articles have the potential of convincing Canadian psychologists to become more active in cost research and, thus, to contribute to advocacy efforts for better mental health services in Canada. Escalating costs represent, without a doubt, one of the major problems facing Canada's public health-care system. All provincial/territorial health plans are presently under immense financial strain. This is a consequence of several factors, including the cost of mental disorders. One estimate of the economic cost of mental disorders in was $14.4 billion in 1998, a little more than 25% of the total invested in public health care that year (Bland, 1998). Despite this, our public system continues to invest disproportionately in the treatment of physical diseases, particularly those associated with death. Why is that? What can Canadian psychology do about it? When I was President of the Canadian Psychological Association (CPA), I became quite interested in advocacy. John Service and I developed a guide to help Canadian psychologists in their advocacy efforts (Gauthier & Service, 1999). One of the critical things that I learned early in the process was to rely on data to convince Members of Parliament that investing in psychology would improve both health and medical outcomes. Such an investment would ultimately result in cost savings. Without data, Members of Parliament would not not be convinced. As a scientist and a practitioner interested in anxiety disorders and as a co-president of a provincial association for anxiety disorders (Association/Troubles Anxieux du Quebec - ATAQ), I welcome the initiative taken by Canadian Psychology/Psychologic canadienne to publish two review papers dealing with the economic cost of anxiety disorders and their treatment. I also thank the Editor of Canadian Psychology /Psychologie canadienne for inviting me to comment on these papers. It is an honour and a privilege for me to do so. I now turn to the review papers. In each instance, I make general and specific comments. I present these comments in the order in which the relevant issues appear in each paper. Thus, the order of my comments does not reflect their level of importance. Paper by Koerner et al. I begin with the paper entitled The Economic Burden of Anxiety Disorders in Canada by Koerner, Dugas, Savard, Gaudet, Tttrcotte, and Marchand. title of their paper suggests that the main focus of the paper is the costs of anxiety disorders. However, generalized anxiety' disorder (GAD) is the only anxiety disorder that these authors examined closely. Introduction. authors are clearly aware of what is happening in the political arena. They refer to the final report of the Commission on the Future of Health Care in chaired by Romanow (Canada, 2002) and the Canadian Psychological Association's advocacy effort in the inquiry. They also highlight the fact that the recommendations put forth in the final report did not show a great deal of concern for mental health problems in Canada. I agree with the authors that one of the major reasons for GPA's limited impact on the Romanow Royal Commission may have been its reliance on evidence derived, for the most part, from research conducted in the United States - in the absence of Canadian data - to demonstrate the relationship between mental and physical health, and the costs associated with psychological disorders. …

Personal Reflections on 60 Years of Psychology: Many Roads to Truth.

Abstract The author selects from her 60 years of personal experiences examples of conflicting views within the profession of psychology on the means of discovering and creating knowledge and truth. She presents vignettes of differences that occur within professional education, research, the regulation of the profession, and belieft about diversity. Aspirational ethics, as in the Canadian Code of Ethics for Psychologists, is inspiring and unifying in using moral principles to bring together apparently divergent people and divergent views to serve our common humanity. Diversity can enrich. CPA's motto of Advancing Psychology for All is a commitment to place the welfare of society individually and collectively above self-interest. Over 60 years of personal encounters with the many tongues, many dreams, many colours, and many struggles of psychologists to discover the truths about human behaviours have led me to believe that there are many paths to follow in the creation of knowledge. My beginnings are clearly rooted in western Canada, in the climate of social activism of prairie politics, and the belief that psychological practice contributes to healthier lives. My reflections are personal and selective and do not reference all the great achievements of Canadian psychologists. My parents believed that education was the road to a better world. Scientific knowledge applied to the welfare of society would eliminate poverty, war, and discrimination, and bring about social justice. A better world would be egalitarian and just, with all people sharing the resources and pleasures of life. I saw psychology as a pathway to truth and social justice. However, snapshots from my life's journey demonstrate some sharply differing views on what psychology is all about, and competing tongues on the nature of truth. Education Sixty years ago, I took two very different courses at the same summer school at the University of Alberta. Dr. John M. MacEacheran (1877-1971) taught the philosophy course that explored the nature of truth, knowledge, and the process by which people seek and achieve wisdom. Dr. Douglas E Smith (1912-1995) taught us about how experimental research and measurement led to a knowledge of truth. I wrote two final exams, one after the other answering similar questions, but I can assure you that I offered different versions of the truth. I received good marks from both instructors. Dr. MacEacheran had studied Mental and Moral Philosophy at Queen's University, and experimental psychology with Wilhelm Wundt in Germany before establishing the Department of Philosophy and Psychology at the University of Alberta in 1909. In 1938-39, he was charged with writing the constitution for the newly formed Canadian Psychological Association and he became its first Honorary President (Pettifor, 1982). he was scholarly, kindly, and interested in social problems. he chaired the Eugenics Board in Alberta for many years, presumably to ensure that there were no abuses in implementing the Act that allowed for the sterilization of those with serious genetically transmitted diseases. Our concepts of respect for human rights and for diversity have changed since that time. This man was highly respected for his many achievements, but, he is much maligned today because of his association with the Eugenics Board. Dr. Smith spent the World War II years as a Staff Officer in the Directorate of Personnel Selection at National Defense Headquarters in Ottawa. He returned to the University of Alberta, served as Head of the Department of Philosophy and Psychology 1952-57, and Chair of the Department of Psychology in 1960 when it became independent of philosophy. he reshaped the department in the belief that experimentalists would have an understanding of community needs and practitioner problems (Pettifor, 1982). he had measurement stories to tell. This was a time when the disclosure of Nazi experimentation on human beings was supposed to be shocking the world into recognizing the need to protect human research subjects, but I do not recall any mention of ethics or of institutional ethics review boards. …

The Use of Knowledge From Outside I/O Psychology by I/O Psychologists: A Critique.

Abstract The aim of the present paper was to comment on three different I/O initiatives involving the transfer of knowledge from outside I/O psychology into the workplace. Overall, it is concluded that the authors have been quite successful at demonstrating that knowledge of theory and research in other fields have enabled them to make some original contributions of their own to I/O psychology. However, it is noted that they draw techniques and constructs from different sources regardless of their conceptual bases, and without the support of a functional analysis of the factors affecting the situation they wish to address. To avoid being left with unenlightened technical eclecticism, it is suggested to them to ground their ideas in a comprehensive and unified theory of human functioning, to ascertain their assumptions about the factors governing human functioning in a work situation through a functional analysis of these factors, and to consider the whole body of knowledge on one issue before choosing a technique to intervene. They are also encouraged to work closely with psychologists in other subdisciplines so as to choose more wisely what knowledge to apply from what field to deal with a given issue in the workplace. Dissemination and integration of knowledge within psychology may be one of the most important problems facing psychological science. In 1997, while I was President of the Canadian Psychological Association, I had the honour and the privilege to chair the National Conference on Psychology as a Science with Anthony Phillips in Aylmer, Quebec (Gauthier & Phillips, 1998). One of the goals of the conference was to identify how psychology as a discipline could make a meaningful contribution to the national research agenda to deal with the enormity and the complexity of the nation's social, health, economic, and environmental problems. To develop effective plans, it was essential to have the collaboration of all the subdisciplines of psychology. But skepticism and mutual distrust were rampant. Accordingly, it proved to be quite a challenge to convince some of them to participate in the conference. It proved to be a greater challenge still to get some of them to communicate with one another. The good news is that the different camps were able to overcome their skepticism and their mutual distrust. In the end, not only the conference was successful in attaining its goals but also delegates to the conference were able to articulate a vision of the field of psychology that they could all support and that encompassed the complex interplay among biological, cognitive, emotional, and social determinants of human functioning. Everyone left Aylmer with a better knowledge, understanding, and appreciation of research and training in the fields that were not his or her own. The National Conference had broken through intradisciplinary barriers. It had set the stage for further cooperation and, as such, it had paved the way for other challenging initiatives. As a scientist and a practitioner who is committed to bridging the gap between various bodies of knowledge (Gauthier, 1999; Gauthier & Phillips, 1998), I welcome the initiative that was taken by Gary Latham with some of his current and former students in industrial/organizational (I/O) psychology to encourage the dissemination and integration of psychological knowledge within the discipline. I also wish to thank him for inviting me to discuss the papers that were presented at the 2001 CPA annual meeting. For a clinical psychologist who has become interested over the past few years in the transfer of knowledge from clinical psychology into the workplace, this is an enriching and stimulating experience. Overview I will now review and comment briefly on each paper. I will conclude with some general remarks about how the authors could benefit even more from reading the literature outside I/O psychology. The Paper by G. …

Toward a Boundaryless Psychology.

[HEADNOTE] Abstract This series of papers argue for the integrating of psychology as a core discipline. They show the benefit to the science and practice of psychology, of psychologists being aware of and building upon theory and research outside their subspecialty. Specifically, the three respective papers examine potential advances in I/O psychology through knowledge of clinical, social, and neuroscience psychology. A primary goal of my presidency of the Canadian Psychological Association (1999-2000) was to create a boundaryless psychology. This goal was based in part on my observation that fields outside of psychology such as the biological and neurosciences often learn about discoveries by scientists who meet at the annual meeting of the Canadian Brain, Behavior and Cognitive Sciences before their colleagues who meet annually at CPA's convention; it was based in part on the knowledge that people in industrial-organizational (I/O) psychology are seldom aware of advances in social and personality psychology despite the overlap in the three subject matter domains; and it was based in part on the observation that the clinical psychology literature is seldom cited by I/O psychologists despite the fact that these are the two groups in psychology who explicitly embrace the scientist-practitioner model. In summary, it was based on the belief that the continued growth of a multitude of subspecialties will lead to independent psychologies unwilling, incapable, or both, of communicating with one another. As Benjamin (2001) noted, this fragmentation can lead to the disappearance of psychology altogether as its subspecialties become absorbed into such fields as neurosciencc, cognitive science, education, health care, and management. An initial step that was taken to attain this goal of boundarylessness was my nomination, and the Board's approval of Bandura as CPA's Honorary President (1999-2000). Bandura was born in Alberta, attained his undergraduate degree at the University of British Columbia, and received his PhD under the supervision of Kenneth Spence at the University of Iowa. Bandura was asked to serve as the Honorary President because his research demonstrates the value of minimizing, if not eliminating, the boundaries or walls that currently exist within psychology. His social cognitive theory (Bandura, 1986, 1997) has influenced the science and practice of clinical, educational, developmental, industrial-organizational, and social psychology. In his honorary presidential address, Bandura (2001) focused on the growing unease regarding the integrity of psychology as a core discipline, and the belief by some that, similar to zoology, psychology is in danger of obsolescence through divestiture to multi-disciplinary programs structured around a common interest. In contrast to the proclamations of the demise of psychology, Bandura documented cogently that psychology is the one discipline that uniquely encompasses the complex interplay among intrapersonal, biological, interpersonal, and sociostructural determinants of human functioning: It is ironic that an integrative core discipline, that deals with the whole person acting in, and on environments, should consider fractionating, farming out subpersonal parts to other disciplines. The field of psychology should be articulating a broad vision of human beings not a reductive fragmentary one. (Bandura, 2001, p. 13) Elsewhere, Bandura (2001, p. 13) noted that our psychological discipline is being split and dispersed by intradisciplinary squabbles and power struggles, rather than by conceptual importance. Hence a second step that the CPA Board took at the 2000 annual meeting was to seek approval from the membership to ask the Canadian Chairs of Departments of Psychology, (Education), Canadian Cognitive Brain and Cognitive Sciences (Science) and the Canadian Provincial Associations of Psychology (practice) to accept seats on the Board. …

Cost effectiveness and medical cost-offset considerations in psychological service provision.

Abstract Empirical evidence has demonstrated that psychological interventions can effectively treat a wide range of child and adult health problems. The focus of this review is on costing issues associated with psychological interventions, including cost-effectiveness and cost offset (i.e., a reduction in health care costs attributable to effective intervention). Recent evidence has demonstrated that psychological interventions can be more cost-effective than optimal drug treatment. For example, although having comparable effectiveness, cognitive-behavioural treatments for panic disorder and for depression have been estimated to cost approximately one-third less than pharmacological treatment. Furthermore, a recent meta-analysis of 91 research studies published between 1967 and 1997 found that average health care cost savings due to psychological intervention were in the range of 20-30% across studies, and 90% of the studies reported evidence of a medical cost offset. In conclusion, the evidence indicates that psychological treatments (i) can be cost-effective forms of treatment and (ii) have the potential to reduce health care costs, as successfully treated patients typically reduce their utilization of other health care services. Based on decades of research on the effects of psychological interventions, there is clear and compelling evidence that there are psychological interventions that are effective in treating a wide range of child and adult health problems, including depression, generalized anxiety disorder, panic disorder, post-traumatic stress disorder, eating disorders, substance abuse, and chronic pain (Chambless & Ollendick, 2001; Nathan & Gorman, 1998; Roth & Fonagy, 1996; U. K. Department of Health, 2001). As research continues to progress, there is mounting evidence that there are also effective psychological treatments for diseases and disorders that are routinely seen in primary care medical practices but that are typically difficult to medically manage, including Type I diabetes (Hampson et al., 2000), chronic tension-type headaches (Holroyd et al., 2001), rheumatoid arthritis (Sharpe et al., 2001), chronic low-back pain (van Tinder et al., 2000), chronic fatigue syndrome (Whiting et al., 2001), and a range of medically unexplained physical symptoms (Nezu, Nezu, & Lombardo, 2001). Evidence for the positive impact of psychological treatment is obviously important, but in the current context of accountability and cost containment, it is, on its own, insufficient (Mash & Hunsley, 1993). Psychologists involved in professional and public policy activities are well-aware of the critical need for data that address the costs associated with psychological services and the benefits - both in terms of health and economic factors - that are likely to result from these services (Dobson, 2002). Indeed, both national and provincial psychological associations have recently made submissions to government departments and commissions emphasizing the savings to the health care system that could result from greater accessibility to appropriate psychological services (e.g., Canadian Psychological Association, 2001; l'Ordre des Psychologues du Quebec, 2000; Manitoba Psychological Society, 2001; Saskatchewan Psychological Association, 2001). The primary goal of this article is to better acquaint psychologists with the costing concepts that can be, and have been, applied to the realm of psychological interventions and with the results of this line of research. I begin by reviewing the current fiscal situation in Canada as it relates to health care costs in general and psychological services more specifically. Next, an introduction to costing concepts is provided and analytic strategies for evaluating health care costs are presented. The next two sections deal specifically with evidence regarding cost savings that are likely to result from psychological treatment. Evidence for the costeffectiveness of psychological intervention versus pharmacologic intervention is presented for the treatment of two common psychological disorders: panic disorder and depression. …

Human neuropsychology in Canada: The 1990s (a review of research by Canadian neuropsychologists conducted over the past decade).

Neuropsychological research in Canada, set in motion by the mid-century work of a handful of Canadian pioneers, has continued and indeed flourished over the past five decades. From Donald O. Hebb's 1949 seminal book, Organization of Behavior, to today's rich and diverse investigations of brain-behaviour relationships, Canadians have repeatedly been at the forefront of human neuropsychological research. Our review of human neuropsychological research in Canada in the 1990s will serve to illustrate the depth and breadth of these investigations and demonstrate this country's pivotal role in a scientific discipline that continues to grow in an exponential manner.Our aim is to review the research activity in human neuropsychology that has taken place in Canada during the decade of the 1990s, and to examine major trends in research focus that have occurred over the past three decades. This work represents the third review in a series that began in 1981, when Rourke, Fisk, Strang, and Gates published their review of Canadian human neuropsychology research for the 1970s. Fuerst and Rourke (1995) conducted a similar review for the decade of the 1980s. First, a brief description of the method used to collect the research of the 1990s is reviewed, followed by summaries of work that has been conducted in Canada over this decade. Next, specific predictions regarding research and service delivery in human neuropsychology in the 1990s that were generated by Rourke (1991a) are evaluated using the information collected through this method. In the final section, other major trends in human neuropsychology in the 1990s are examined.To collect the information, a list of over 200 Canadian neuropsychologists was compiled from the membership rosters of the Canadian Psychological Association, Division 1 (Brain and Behaviour) and Division 23 (Clinical Neuropsychology), the International Neuropsychological Society, and the National Academy of Neuropsychology, as well as from the previous two reviews. Each psychologist was sent a letter describing the project and requesting reprints or lists of their research in human neuropsychology that had been published between 1990 and 1999, inclusive. The response rate was approximately 32% (i.e., 81 neuropsychologists) and resulted in the collection of over 1,100 references to articles, chapters, and books. Although less than half of the neuropsychologists contacted for this survey responded with lists of relevant publications, it should be noted that in a 1994 survey, Putnam, Deluca, and Anderson found that approximately 15% of clinical neuropsychologists in North America had produced 84% of the existing neuropsychology publications. Therefore, the works collected for the present review are probably a reasonably representative sample of neuropsychological research in the last decade in Canada.Before proceeding with the review, its scope and limitations will be briefly described. Fuerst and Rourke (1995) reported that the extraordinary volume of research conducted in Canada during the 1980s necessitated limiting their review to selected investigations generated by prominent researchers in major centres across the country. Given the further growth in neuropsychological activity during the last decade, we also regret that it was impossible to review all of the research conducted during this time period. Whereas the production of such an immense amount of research over a 10-year period is a clear indication of this country's continued leadership in this field, this also made it impossible to include much work that deserved attention.For the current study, we focused primarily on a self-selected pool of Canadian neuropsychologists as stated above but we attempted to include the work of as many respondents as possible and sought material from various prominent Canadian researchers not belonging to the aforementioned professional groups. At times, space limitations forced us to include only the work of researchers who had published multiple and/or seminal pieces of work during this time period. …

The codes of ethics of the Canadian Psychological Association and the Canadian Medical Association: Ethical orientation and functional grammar analysis.

Abstract The Canadian Code of Ethics for Psychologists (Canadian Psychological Association, CPA, 2000) has been the subject of several recent investigations. This work has focused, for example, on the validity of its hierarchical organization of ethical principles. In the present research, we subjected the code to both a content and a functional grammar analysis. Our content analysis was aimed at determining the theoretical ethical orientation (i.e., deontological, teleological or caring) of each statement in the document, while the functional grammar analysis provided information about implicit messages embedded within the code. We contrasted the results of our analysis with those of previous work on the code of ethics adopted by the Canadian Medical Association (CMA). We concluded that, compared to CMA's code, the CPA document has greater educational value, is less authoritarian, provides a clear rationale for ethical behaviour, and is more empowering to the decision-maker. We argue that the results of our functional grammar and content analyses have implications for future attempts to improve ethics codes for psychology and other professions. Many organizations and most national professional associations have adopted codes of ethics. Such documents serve an educational function (e.g., O'Neill, 1998) and communicate important expectations to the membership of these organizations. Codes also serve to facilitate a profession's ability to self-regulate. They may also function as a means by which members can question their own personal values as they relate to their professional role (Meyer, 1987). Externally, codes of ethics assure the public, clients, and other stakeholders that members of a profession are competent, have a high level of integrity, and are able to enforce high moral standards (Pettifor, 1996). Codes of ethics also help professionals commit publicly and explicitly to their association's values, norms, beliefs, and philosophy and make them accountable (Dunbar, 1998; Pettifor, 1996). The Canadian Code of Ethics for Psychologists (Canadian Psychological Association, 1986, 2000) was designed to incorporate the collective wisdom of Canadian psychologists (Sinclair, Poisner, GilmourBarrett, & Randall, 1987). Sinclair et al. (1987) described the methodology that was used in the code's development. Briefly, the process involved the creation of 37 vignettes describing hypothetical ethical dilemmas. The dilemmas related to the ethical principles that were articulated in the 1977 edition of the code adopted by the American Psychological Association (APA, 1977). They also involved conflicts between ethical principles as well as psychological practice issues and situations involving innovative but untested approaches. Sinclair et al. formulated questions to elicit self-accepted ethical principles. They asked 400 Canadian psychologists to each respond to a series of questions about a portion of the vignettes. One hundred and twenty-five agreed to participate but only 59 responses were received. The researchers submitted these responses to a content analysis that focused on the reasons provided for the courses of action selected by the respondents. They organized the relevant statements into categories that reflected superordinate ethical principles. The resulting document consisted of four fundamental ethical principles (Respect for the Dignity of Persons, Responsible Caring, Integrity in Relationships, and Responsibility to Society). A consultative process with provincial regulatory bodies supported the validity of the document. Although the code has since undergone revisions, it still is based largely on the original document and its four fundamental ethical principles (CPA, 2000). The CPA (1986, 2000) code has received plenty of praise for its coherence, organization, and unique features (e.g., Booth, 1998; Dixon, 1998; Hadjistavropoulos & Malloy, 2000; Sinclair, 1998; Wassenaar, 1998); however, empirical research (e. …

Preferred strategies for learning ethics in the practice of a discipline.

Abstract There are very few formal evaluations of the impact of instructional practices on the effectiveness of strategies for learning professional ethics. The assessment of ethical knowledge and skills is important in current discussions of professional mobility across North American jurisdictions. The present study investigated adult learners' perceived level of helpfulness of seven strategies when learning seven different ethical content areas. Adult learners rated interactive strategies as more helpful for learning compared to traditional didactic methods. Adult learners rated the helpfulness of various strategies differently for different content areas, indicating that several strategies may be useful. We conclude by making recommendations for further investigation of the effectiveness of various learning strategies in terms of knowledge gained and subsequent behaviour. The increasing emphasis on ethical issues in the science and practice of psychology requires psychologists to carry out more empirical studies on the effectiveness of learning strategies. There are very few published evaluations of the effectiveness of instructional practices or outcomes in the teaching of ethics in psychology. Faculty, thus, are relying on the good-hearted assumptions that current ethics courses have been appropriately designed (Welfel, 1992). The literature relating to ethics and professional accountability in psychology was almost nonexistent until after World War II, but it has increased significantly since the 1970s (Sinclair, 1993). The impetus for addressing ethics may have come from two precipitating factors. One was the postwar disclosure of atrocities conducted in Nazi Germany in the name of science. The other was the rapid postwar professionalization of applied psychology (Sinclair, 1993; Sinclair, Simon, & Pettifor, 1996). The first formal regulation of psychological practice in North America began in Connecticut in 1945. Since then American states and the Canadian provinces have all adopted regulatory legislation. Regulation requires the definition of standards for competent and ethical practice. Ethics questions are included on the Examination for Professional Practice of Psychology and on oral examinations that are required by most regulatory jurisdictions (Association of State and Provincial Psychology Boards, ASPPB, 1999). The accreditation of professional training programs in Canada and the United States requires the teaching of ethics (American Psychological Association, 1996; Canadian Psychological Association, 1991b). Professions develop codes of ethics to guide the behaviour of their members in the practice of their discipline. Aspirational codes of ethics articulate the fundamental moral values on which behavioural standards are based. Professional disciplines avoid intruding on the personal values and behaviours of members as long as they do not bring discredit to the profession (Pettifor, 1996). Nevertheless, the underlying values of codes of ethics reflect the cultural values and mores of the society in which they are formulated, and therefore significant conflict between personal and professional values normally would not occur. Professions may also develop codes of conduct to define specific behaviours that are expected of members and for which violations may incur disciplinary sanctions (Association of Provincial and State Psychology Boards, 1991). All professional codes of ethics and codes of conduct address in one way or another the issues of respect, rights, confidentiality, informed consent, diversity, well-being of consumers, competency, professional boundaries, conflict of interest, honesty, and, sometimes, responsibility to society. Psychologists require knowledge of the profession's requirements for ethical standards and they require skill in recognizing and resolving ethical dilemmas. Strategies for developing knowledge may differ from strategies for developing skills. …

A national imperative: Public funding of psychological services.

CPA Award for Distinguished Contributions to Psychology as a Profession (2001) - Prix de la SCP pour contributions remarquables a la psychologie en tant que profession (2001) Abstract This article discusses the history of Canadian psychology and the publicly funded health care system. Reasons are provided for the current situation, in which psychology is largely not publicly funded, and the current situation in psychology is contrasted with that history, to make the argument that modifications are possible. Different models and methods of funding, related to service providers, service recipients, and the actual services themselves are reviewed. An argument is made that public funding should be provided to clinical psychologists who provide empirically supported services to patients with diagnosable mental health problems. The article concludes with a response to some anticipated criticisms of the position taken, and ideas about political advocacy to advance the agenda of public funding of psychological services. One of the distinct pleasures of being recognized for the Canadian Psychological Association Award for Distinguished Contributions to Professional Psychology is the opportunity to contribute an article to Canadian Psychology. In considering which domain to write about in this privileged document, I naturally considered depression, as it is the area in which I have done most of my research during my academic career. In the end, however, I could not resist the opportunity to use this forum to advocate a matter of public policy related to the psychological services, that has been, at least from my perspective, a discredit to the profession of psychology and to public servants responsible for publicly funded health services in Canada, alike. I am speaking of the fact that psychology is not yet recognized in any province as an essential part of the health system, in as much as psychological services are not directly funded under provincial medicare. In this article, I will briefly review some of the factors that have contributed to the current situation, discuss some of the reasons why this is an opportune time to modify the relationship between psychology and medicare, and elucidate some of the mechanisms whereby that development may be made. Finally, I will anticipate some of the reactions for critique of the proposals that will be generated, in what I hope will be a final argument in support of psychology being directly funded under provincial medicare plans. HOW DID WE GET HERE? Although the concepts of universal health care, as elaborated in the Canada Health Act (Government of Canada, 2001), are widely subscribed to by Canadians, it is worth noting at the outset that this vision is relatively recent, only having been adopted in its current form at the federal level in 1984. The Canada Health Act requires that all medically services be universally available, but the actual definition of medically does permit some regional variance, and no national definitive list of essential or necessary services exists. Further, to the extent that different provinces have the financial ability and political mandate or will, they may offer services that would not be deemed necessary, but which are considered part of the overall social good. Services that are considered nonessential today can become part of the list of funded services in the future, as new information about their efficacy or beneficial side effects becomes known. In this regard, evidence of cost-offset may be a highly potent force to convince provinces to include new services in those that they fund. Notwithstanding the fact that psychology as a discipline is more than a century old, and that even clinical psychology within the overall discipline has more than a century behind it (McReynolds, 1996), the fact is that psychology is a relatively recent partner in the panoply of health service providers in the Canadian context. …

Recovered Memories: Ethical Guidelines to Support Professionals

ABSTRACT There is a need for guidelines on recovered memories to support the work of professionals and provide protection for clients. This paper highlights the value added by the Canadian Psychological Association's Guidelines for Psychologists Addressing Recovered Memories (Crozier and Pettifor, 1996) in assisting professionals to deal with ethical issues in this area. The Guidelines in combination with a rational and intuitive ethical decision-making process are applied to three vignettes involving sexual abuse and possible recovered memories. This paper offers professionals an opportunity to review their practice according to approved Guidelines for dealing with the difficult issue of recovered memories.

The relative importance of the ethical principles adopted by the American Psychological Association.

Abstract A primary purpose of a code of ethics is to assist members of an organization in making consistent choices when faced with ethical dilemmas. In instances where two or more ethical principles are in conflict with one another, decision-makers are typically left to determine which of the two should be given most weight. Nonetheless, in the code of ethics adopted by the Canadian Psychological Association (CPA), principles are ranked in order of importance. This provides decision-makers with guidance in situations of conflict between ethical principles. In contrast to CPA's code of ethics, other professional codes do not provide such guidance. In a previous paper, we provided a philosophical rationale for a ranking of the ethical principles adopted by the American Psychological Association (APA) in order to help guide decision-making (Hadjistavropoulos & Malloy, 1999). In the present study, we investigated whether APA members collectively believe that some ethical principles are more important than others, and whether their views about the relative importance of ethical principles are consistent with the order (i.e., ranking) outlined in the CPA code. The results suggest that although APA members view all principles of their code as being important, they also view certain principles as carrying more weight. A discussion of the similarities and differences between a ranking of ethical principles that was based on our participants' responses and that of the CPA code is provided. The implications of the findings for ethical decision-making are also discussed. A primary purpose of any code of ethics is to provide members of an association with guidance for making consistent ethical choices. Principles and standards are used to specify for members the nature of what the organization/association deems to be ideal and/or expected conduct (Railborn & Payne, 1990). The ethical principles listed in the code of ethics adopted by the Canadian Psychological Association (CPA, 1991, 2000) are ranked in order of importance. This approach was intended to increase consistency of ethical decision-making in situations where ethical principles are in conflict with one another (Hadjistavropoulos & Malloy, 2000; Sinclair, 1998). In contrast to the CPA code, the code of ethics adopted by the American Psychological Association (APA, 1992) does not include a ranking of ethical principles. The APA (1992) code is of interest to Canadian psychologists because it reflects the practices of the largest psychological association in the world and is a highly visible and influential document within international psychology. Moreover, approximately 2,000 Canadian psychologists are members of APA (APA, 2000). The code of ethics of the american psychological association (APA, 1992) includes six ethical principles (Competence, Integrity, Professional and Scientific Responsibility, Respect for People's Rights and Dignity, Concern for Others' Welfare, and Social Responsibility). It is not difficult to think of situations in which some of these principles can come into conflict with other principles. Consider, for example, a well-meaning parent who wishes to make a choice for his child that the psychologist believes is not in the best interest of the child (Hadjistavropoulos & Malloy, 1999). In such a situation, principles that relate to client autonomy (e.g., Respect for People's Rights and Dignity) would conflict with those that pertain to concern for the welfare of others (e.g., Concern for Others' Welfare). Most codes of ethics do not provide guidance with respect to the manner in which such conflicts should be dealt with, thus, increasing the probability of inconsistent decision-making among psychologists. As mentioned earlier, the issue of conflict among ethical principles has been addressed by CPA (1991, 2000). The four principles of CPA's code are ranked as follows: 1) Respect for the Dignity of Persons; 2) Responsible Caring; 3) Integrity in Relationships; and 4) Responsibility to Society. …

An Interview with Henry L. Roediger III

Henry L. Roediger III is presently the James S. McDonnell Distinguished University Professor of Psychology at Washington University in St. Louis and Chair of the Psychology Department. Dr Roediger has published about 150 articles and chapters, mostly on issues concerning human memory. He is coauthor of three textbooks (which have been through a combined 18 editions) and has coedited four other books. He was Editor of the Journal of Experimental Psychology: Learning, Memory and Cognition from 1985 to 1989 and was the founding Editor of Psychonomic Bulletin & Review (1994 98). He has served as President of the Midwestern Psychological Associa tion, Chair of the Governing Board of the Psychonomic Society, President of Division 3 (Experimental Psychology) of the American Psychological Association, and on the Board of Directors of the American Psychological Society. He is a Fellow of the American Association for the Advancement of Science, the American Psychological Association, the American Psycholog ical Society, and the Canadian Psychological Association. He was elected to the Society of Experimental Psychologists in 1994 and held a Guggenheim Fellowship for the 1994-95 academic year. According to a study by the In stitute of Scientific Information that covered the years 1990-94, papers by Dr Roediger had the greatest impact (average citation count) of those of any psychologist during this period. Roediger was recently elected Presi dent of the American Psychological Society and will serve his term during 2003-2004 academic year. In this interview, he discusses his current research and examines cru cial concerns regarding memory, false memories, hypermnesia, educational psychology, and the field of education in general.