Profesionalna etička uverenja i postupci kliničkih psihologa u Srbiji

Abstract

Ovaj rad nastao je kao posledica saznanja da je u našoj zemlji oblast profesionalne etike u psihologiji veoma slabo razvijena, kako u pogledu empirijskih istraživanja, tako i u pogledu naučnih radova uopšte, kao i u zastupljenosti ove teme na studijskim programima za buduće psihologe. Tema ove disertacije je profesionalna etika kliničkih psihologa. U okviru njene izrade sprovedena su dva istraživanja sa ciljem da se osvetli oblast profesionalne etike sa empirijskog, ali i teorijskog stanovišta. Prvo je bilo fokusirano na preventivne mere za sprečavanje etičkih prekršaja psihologa. Analiziran je istorijat etičke regulacije u vidu formalnih procedura, sprovedenih od strane sudova časti strukovnih udruženja koje okupljaju, između ostalog, i kliničke psihologe. Istraživanje je bilo eksplorativnog tipa i obuhvatalo je vremenski period od 1953. do 2012. godine. Osnovne metode istraživanja bile su: kvalitativna istorijska analiza, frekvenijska analiza i ispitivanje putem polu-strukturisanih intervjua. Ispitivan je angažman intervjuisanih u radu sudova časti, slučajevi i problemi sa kojima su se susreli, kao i njihovo mišljenje o efikasnosti rada ovih sudova. Analiziran je rad Suda časti Društva psihologa Srbije i Suda časti Saveza društava psihologa Srbije. Rezultati ovog dela istraživanja pokazuju da je za 40 godina postojanja Sud časti DPS primio 16 pritužbi na rad psihologa, od čega 3 na rad kliničkih psihologa. Pritužbe se u najvećoj meri odnose na njihovu stručnost i kvalifikovanost, kao i na neprihvatljiv odnos sa kolegama. Od 16 pritužbi, ovaj Sud je razmatrao 7, a u 3 slučaja doneo okrivljujuću presudu i izrekao prilično blage kazne. Sud časti SDPS je za 15 godina postojanja primio samo jednu pritužbu, ali ona nije razmatrana zbog nedostatka dokaza. Dobijeni rezultati ne odstupaju u velikoj meri od rezultata sličnih istraživanja u SAD, Kanadi, Južnoj Africi i Velikoj Britaniji, kada je u pitanju procenat Sudu prijavljenog v članstva u toku jedne godine. U radu su razmatrani mogući razlozi za mali broj prijavljenih slučajeva i blage kazne, a istaknute su i neke poteškoće sa kojima se Sud časti DPS tokom svog rada susretao, a koje bi mogle objasniti zašto je situacija takva kakva je, kao što su npr. prebacivanje odgovornosti na druge i izbegavanje sukoba sa kolegama. U fokusu drugog istraživanja bili su profesionalna etička uverenja i postupci kliničkih psihologa u Srbiji. Ovo istraživanje je zamišljeno i sprovedeno kao neeksperimentalno eksplorativno istraživanje anketnog tipa. Uzorak se sastojao od 204 klinička psihologa, koja rade na teritoriji Republike Srbije. Od instrumenata su korišćeni: 1) Instrument za prikupljanje socio-demografskih i drugih karakteristika ispitanika (konstruisan od strane autora disertacije), 2) Instrument za ispitivanje etičkih uverenja i postupaka (ponašanja) autora Keneta Poupa, Barbare Tabačnik i Patricije Kejt-Špigel (1987), kao i 3) Upitnik za ispitivanje etičke pozicije Donelsona Forsajta (1980). Rezultati istraživanja pokazali su da se mali broj kliničkih psihologa u Srbiji upuštao u najteže etičke prekršaje (kao što su npr. seksualni odnosi sa klijentima) i to veoma retko. Međutim, svi ispitanici iz uzorka napravili su najmanje pet etičkih prekršaja tokom svoje karijere. Najveći deo kliničkih psihologa pružao je profesionalne usluge pod velikim stresom i odbio da klijentima saopšti dijagnozu. Profesionalna etička uverenja psihologa o većini postupaka u skladu su sa njihovim ponašanjem. Isti nalaz dobijen je i u sličnim istraživanjima u drugim zemljama. Međutim, primećene su i određene kulturno uslovljene razlike u uverenjima i postupcima u poređenju sa nalazima sličnih istraživanja sprovedenih u SAD, Španiji, Italiji, Izraelu, Kini i Australiji. Takav je npr. nalaz da čak petina ispitanika smatra da je neetično prijavljivanje kolege, koji je prekršio profesionalnu etiku, Sudu časti. Ovaj podatak delimično objašnjava mali broj prijavljenih slučajeva, koji je otkriven u prvom istraživanju. Sa druge strane, očigledno je da je tamna brojka neotkrivenih i neprijavljenih slučajeva znatno veća. vi Pored toga, u drugom delu istraživanja, utvrđeno je da: 1) ispitanici iz srednjih i malih gradova u većoj meri ulaze u maligne neseksualne višestruke odnose i prave veći broj etičkih prekršaja pri kliničkoj proceni od ispitanika iz velikih gradova; 2) muškarci, klinički psiholozi, u većoj meri nego žene prelaze granice sa klijentima, stupaju u seksualne odnose sa njima i ponašaju se nekompetentno tokom obavljanja posla; 3) klinički psiholozi, u srednjem zrelom životnom dobu, koji imaju decu i opisuju svoju materijalnu situaciju kao bolju od one, koju ima većina porodica u Srbiji, u većoj meri prelaze granice sa klijentima; 4) ispitanici sa dužim radnim stažom su u većoj meri prelazili granice, upuštali se u maligne neseksualne višestruke odnose i pravili etičke prekršaje u psihodijagnostici; 5) ispitanici, koji nisu upoznati sa Kodeksom etike DPS u većoj su meri postupali nekompetentno u svom radu, upuštali se u maligne neseksualne višestruke odnose, u seksualne odnose sa klijentima i etičke prekršaje pri kliničkoj proceni; 6) klinički psiholozi, koji nisu pohađali edukativne kurseve iz oblasti profesionalne etike, u većoj meri su se upuštali u maligne neseksualne višestruke odnose, seksualne odnose sa klijentima i neetično ponašanje prilikom psihodijagnostike; 7) klinički psiholozi, koji zastupaju apsolutističku etičku poziciju, odnosno tzv. „kantovski moral“, u manjoj su se meri upuštali u sve, prethodno pomenute, oblike neetičnog ponašanja. Ovi rezultati pokazuju da bi trebalo znatno više raditi na preventivnim merama, pre svega, na edukaciji psihologa o profesionalnoj etici. Propisi Suda časti, kao i postojeći Kodeks etike psihologa Srbije, dobar su osnov za monitoring rada psihologa, ali bi se mogli i unaprediti na osnovu rezultata dobijenih u ovom istraživanju.

This dissertation was based on the realization that in our country the area of professional ethics in psychology is very poorly developed, both in terms of empirical research and scientific papers in general, as well as the representation of this subject in the study programmes for future psychologists. The subject of this dissertation is the professional ethics of clinical psychologists. As part of its fulfillment two studies were carried out with the goal to shed some light on the area of professional ethics from the empirical, but also from the theoretical viewpoint. The first was focused on existent measures for preventing ethical violations of psychologists in our country. The history of ethical regulations in Serbia was analyzed in the form of formal procedures implemented by the Courts of honour of professional associations which include clinical psychologists among others,. The research was exploratory, and it covered the period from 1953 to 2012. Basic methods of this study were qualitative historical analysis, frequency analysis and semi-structured interviews. We investigated the involvement of the respondents in the work of Courts of honour, cases and problems they encountered, as well as their opinion on the effectiveness of these courts. We analyzed the work of the Court of Honour of the Association of Psychologists of Serbia and the Court of Honour of the Union of Serbian Associations of Psychotherapists. The results of this part of the research showed that, in 40 years of its existence, the Court of Honour of the APS has received 16 complaints about the work of psychologists, including 3 about the work of clinical psychologists. The complaints were mostly related to the qualifications and expertise of the psychologists, as well as any undesirable relationship with colleagues. Out of 16 complaints, this Court has dealt with 7, and in 3 cases a guilty verdict was announced and a very lenient punishment imposed. The Court of Honour of the USAP has received a single complaint in 15 years of viii its existence, but it was not dealt with due to lack of evidence. The results obtained do not differ greatly from what similar analyses have shown in the USA, Canada, South Africa and Great Britain, when it comes to the percentage of registered members of the Court during one year. Possible reasons for the small number of reported cases and light sentences were discussed in the paper, and some of the difficulties which the Court of APS met during their work were highlighted, such as passing responsibilities and avoiding unpleasant conflicts with colleagues, which could explain the current situation. The other study was focused on professional ethical beliefs and behaviours of clinical psychologists in Serbia. This study was designed and conducted as a non-experimental exploratory research survey. The sample consisted of 204 clinical psychologists who work in the territory of the Republic of Serbia. The instruments used were: 1) the Instrument for collecting socio-demographic and other characteristics of the respondents (constructed by the author of the dissertation), 2) the Instrument for the examination of ethical beliefs and behaviours by Kenneth Pope, Barbara Tabachnick and Patricia Keith-Spiegel (1987), and 3) the Ethics position questionnaire by Donelson Forsyth (1980). The results of the research showed that a small number of clinical psychologists in Serbia engaged in the most serious ethical violations (such as sexual relations with clients) and very rarely. However, all respondents in the sample have committed at least five ethical violations in the course of their career. Most clinical psychologists provided professional services under a lot of stress and declined to disclose the diagnosis to their clients. Professional ethical beliefs of the psychologists regarding most behaviours are consistent with the behaviours that they exhibited. The same result was obtained in similar studies in other countries. However, there are certain culturally conditioned differences in beliefs and behaviours in comparison with similar studies conducted in the U.S., Spain, Italy, Israel, China, and Australia. Such is the finding that as much as a fifth of the respondents consider that reporting a colleague who violated professional ethics to the Court of Honour is unethical. This fact partly explains the small number of reported cases discovered in the ix first part of the research. On the other hand, it is obvious that the dark figure of unreported and undetected cases is much higher. In addition, the second part of the study found that: 1) respondents from medium and small towns engaged in malignant non-sexual multiple relationships and committed a greater number of ethical violations in clinical assessment than respondents from large cities, 2) male clinical psychologists crossed the line with their clients, had sexual relationships with them and behaved incompetently in their work to a greater extent than female ones, 3) middle aged clinical psychologists who have children and describe their financial situation as better than that of most Serbian families crossed the line with their clients to a greater extent, 4) the longer the tenure of clinical psychologists, the more they crossed the lines, engaged in malignant non-sexual multiple relationships and committed ethical violations in clinical assessment, 5) the respondents who were not familiar with the APS Code of ethics acted incompetently in their work, engaged in malignant non-sexual multiple relationships and sexual relationships with their clients and committed ethical violations in clinical assessment to a greater extent, 6) clinical psychologists who hadn’t attended educational courses in professional ethics, engaged in malignant non-sexual multiple relationships and sexual relationships with their clients and demonstrated unethical behaviour in clinical assessment to a greater extent, 7) clinical psychologists who advocate the absolutist ethical position (Kantian ethics) engaged in all of the aforementioned forms of unethical behavior to a lesser extent. These results suggest that much more work is needed on preventive measures, primarily on educating psychologists about the issues of professional ethics. The regulations of the Court of Honour, as well as the existing Code of ethics of psychologists of Serbia, are a good basis for monitoring psychologists’ work, but could be improved on the basis of the results obtained in this study.