the ethics of using clinical examples in lectures

[compassionate1]

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Hi,

I teach psychology courses as an adjunct instructor ( undergraduate).

I have been teaching for several years, but now that I am also engaged in clinical work, I am wondering what is the ethical way of including clinical examples in lecture for teaching / learning purposes.

Granted, I would only use composite examples and would change enough of the details ( gender, age etc) to ensure that clients' may not be identified. And yet, I am still unsure if this is safe enough, although many clinicians who had authored books use composite examples which are open to broad audiences ( and not just for educational purposes).

Any thoughts?

With appreciation,

Compassionate1

 

[Ollie123]

I'm curious about this as well (and don't have an answer). Since I'm unsure where the lines are drawn, I've always been exceedingly vague when describing cases in courses. Likely far, far more than I needed to be, but figure its best to err on the side of caution. Wondering how others go about this.

 

[Doctor Eliza]

This becomes tricky because presumably your students live in the same town as your clients. It is a really small world (even if you live in a big city). You wouldn't believe how many times I have had my clients mention other clients of mine (without either one knowing that they both see me.)

Composites are better than non-composites, but it still gets tricky. Students my think they recognize someone (even if they are incorrect).

To solve this issue, when providing clinical examples, I kept it extremely short with no unnecessary details. I didn't really describe a case per se, usually just one little aspect of it.

Another good option is to use other people's published case studies. There are many books out there of just this sort of thing. Students tend to like these.

It is hard because students love, love, love case material. But don't be sucked in to doing something unethical to get your students to like you. There was one woman in my program who brought in and showed her undergrads REAL Rorschach cards. They loved it, but she was violating test security. (She was eventually kicked out for other reasons.)

Best,
Dr. E

 

[AcronymAllergy]

This becomes tricky because presumably your students live in the same town as your clients. It is a really small world (even if you live in a big city). You wouldn't believe how many times I have had my clients mention other clients of mine (without either one knowing that they both see me.)

Composites are better than non-composites, but it still gets tricky. Students my think they recognize someone (even if they are incorrect).

To solve this issue, when providing clinical examples, I kept it extremely short with no unnecessary details. I didn't really describe a case per se, usually just one little aspect of it.

Another good option is to use other people's published case studies. There are many books out there of just this sort of thing. Students tend to like these.

It is hard because students love, love, love case material. But don't be sucked in to doing something unethical to get your students to like you. There was one woman in my program who brought in and showed her undergrads REAL Rorschach cards. They loved it, but she was violating test security. (She was eventually kicked out for other reasons.)

Best,
Dr. E

Given that the cards have been in the public domain for years now, one might be able to argue that showing them to a college class (particularly when they're already posted on Wikipedia) isn't necessarily unethical, as there's no longer any semblance of test security. Although personally, when discussing the Rorshach in class, I just showed Rorshach-like images without using any of the actual cards.

As for using clinical examples in class, I agree with the above suggestions--if you use examples from your own experiences, I don't see this as unethical so long as they're kept very brief and generalized (e.g., there's no need to state age other than using, at most, phrases like "young man/young woman"). Although many teaching points, as Doctor Eliza noted, can either be made from already-published case examples, or very general trends experienced in clinical interactions (e.g., "I've worked with phobia clients who...").

 

[roubs]

If you are lecturing to undergraduates why would you have to present it in the typical 'case presentation' format that begins with demographic information? Presumably you are actually trying to highlight something about how the particular illness presents or how treatment works(doesn't work). I don't see how that always requires stating the clients race, age, location etc. It may a bit of richness to the picture, and we do it by rote in a clinical setting with colleagues, but that doesn't mean we have to follow the same roadmap in an undergrad class.

Our ethics guidelines state we should make reasonable efforts to disguise a person's identity. Even if you wanted to discuss something related to a culture I think presenting a client as a "Hispanic male" generally achieves that standard unless you live in a very small community. Instead of worrying if a student knows one Hispanic male who might have a mental health concern and makes a baseless assumption, we should ask ourselves if they can actually identify a person based on race and gender.

 

[KillerDiller]

If you are lecturing to undergraduates why would you have to present it in the typical 'case presentation' format that begins with demographic information?....

This is totally unrelated to anything, but Roubs, what is your new user icon from? I keep going back and forth on whether or not I recognize it.

 

[roubs]

This is totally unrelated to anything, but Roubs, what is your new user icon from? I keep going back and forth on whether or not I recognize it.

Heh, from Sherlock (2010). BBC / PBS shows help me keep it together in grad school.

 

[KillerDiller]

Heh, from Sherlock (2010). BBC / PBS shows help me keep it together in grad school.

Ah, so I guess I did recognize it. 🙂

 

[Pragma]

It is a bit of a grey area, but obviously being conservative is your best bet. I try to think about it in the way I think about research data - get rid of identifiers, etc. As others have mentioned, you've got to consider the community you are in and the potential for someone to be identified.

Now, a great suggestion I got while in training was to actually change details to disguise the person. Perhaps give them a different profession or something like that where it won't affect your point (well, as long as you don't change 'dishwasher" to "surgeon").

 

[PsychPhDone]

It is a bit of a grey area, but obviously being conservative is your best bet. I try to think about it in the way I think about research data - get rid of identifiers, etc. As others have mentioned, you've got to consider the community you are in and the potential for someone to be identified.

Now, a great suggestion I got while in training was to actually change details to disguise the person. Perhaps give them a different profession or something like that where it won't affect your point (well, as long as you don't change 'dishwasher" to "surgeon").

What classes are you teaching? I teach Intro and I only use "cases" in two ways: I use pre-published case studies for a "what is the likely diagnosis?" exercise, and when I talk about ESTs I talk about techniques. I don't talk about specific cases but I might say "Something I do a lot when treating Social Anxiety Disorder is I help the client plan exposures, such as introducing themselves to three new people at a party." I then ask for as many student hypothetical suggestions for exposures as possible, to keep the onus of information-providing on the students. 😉 I occasionally have students ask things like "what's the hardest case you've had?" or "what's the weirdest phobia you've treated?" and I quickly turn it back on them (e.g., "I've found that OCD is hard to treat. Why might that be?")

 

[compassionate1]

Helpful responses everyone -- thanks!

Dr. Eliza:Your point about students often living in the same community as my clients is well taken. I feel that one cannot be careful enough. ( Despite the fact that there is nothing quite like a vivid example!)

Roubs: You are right that sometimes dempgraphics are not essential but when I teach family psychology, age of family members and diversity themes are important.

PsychPhdStudent: I usually teach Intro, Abnormal, and Family Psychology ( therapy)

When clinicians write books using clinical examples, do they always obtain permission of clients? ( I do hope so!) Is it also the case when composites are used rather than distinct cases?

Compassionate1

 

[PsychPhDone]

Helpful responses everyone -- thanks!

Dr. Eliza:Your point about students often living in the same community as my clients is well taken. I feel that one cannot be careful enough. ( Despite the fact that there is nothing quite like a vivid example!)

Roubs: You are right that sometimes dempgraphics are not essential but when I teach family psychology, age of family members and diversity themes are important.

PsychPhdStudent: I usually teach Intro, Abnormal, and Family Psychology ( therapy)

When clinicians write books using clinical examples, do they always obtain permission of clients? ( I do hope so!) Is it also the case when composites are used rather than distinct cases?

Compassionate1

I think it's commonplace to ask permission and change details of clients in books.