listen and talk to patients and others who may

be influenced by their decisions. That is, they need to discuss the issues with
others—including conversations with patients and other affected people, and
formal consultations—and consider the cognitive and emotional influences on
their decision-making process.
A long line of evidence supports the importance of listening to and
talking in social networks to generate good ideas. In his review of the history
of technology and science, S. Johnson (2010) debunked the popular belief
that a lone genius produces great innovations through sudden insights that
advance the state of knowledge by years or decades. In contrast, he argued that
most innovators have a close network of collaborators (or a network through
which ideas are exchanged freely) and that scientific advances are almost
always incremental improvements on existing ideas. Few great leaps occur.
Similarly, psychologists can use networks and connections to improve
the quality of the ideas they generate. Ideas gained from free exchange with
patients, members of patients’ social circles, and by consulting professionals
may lead to insights or interventions that psychologists could not have generated
on their own. For example, consultation groups can be a source of such
useful ideas. As W. B. Johnson, Barnett, Elman, Forrest, and Kaslow (2013)
noted, psychologists increase their competence when they have a network
of relationships with colleagues who take an interest in their professional
well-being.
Listen and Talk (Benefits of Soliciting Input)
Sometimes input comes through formal consultations with other professionals,
who can help address the cognitive and emotional aspects of
decision making. From a cognitive perspective, consultants may be able to
identify sources of knowledge, neglected questions, types of interventions, or
useful resources. From an emotional perspective, they may help psychologists
reduce strong emotional influences, allow them to process information more
clearly, and provide frameworks for their thinking. For example, consultants may
challenge psychologists to explore their perceptions, intuitions, assumptions,
logic, and blind spots; the ethics acculturation model (see Chapter 4) may be
particularly helpful in this regard. The very process of describing a dilemma
to another person may help psychologists to clarify and think through the
dilemma for themselves.
30 ethical dilemmas in psychotherapy
With the goals of testing assumptions and identifying options, it can
be useful to discuss options with the patients or other affected individuals.
In the case of Dr. Yasuto, she needed to consider her patient’s reasons for
opposing the treatment plan (in this case, a psychiatric hospitalization), such
as the lack of availability of child care or fear of losing his job. Dr. Yasuto
may find that her patient is rationalizing to mask his true intentions, or he
may have legitimate problems getting child care and is trying to balance his
need for treatment with other practical concerns. Furthermore, because the
patient is seriously depressed, he may be thinking in a rigid manner such
that he is unable to consider obvious alternatives to address those concerns.
Consider these examples:
Examples of Involving Patients
One psychologist had instituted an involuntary hospitalization of a
patient who suddenly dropped her opposition to going to the hospital
when he told her that he would respect her wishes not to be sent to a
particular one. It turned out that her father had died in that hospital and
she still had great anxiety about going there. Another psychologist had
a patient who suddenly dropped her opposition to going to the hospital
when he told her that he would respect her wishes of going to the hospital
in her family car and not an ambulance. The patient was afraid that the
neighbors would begin gossiping about her if they saw an ambulance drive
away from her house.
Reflect (Cognitive Distortions and Feelings)
As discussed in Chapter 1, nonrational factors influence psychologists’
ability to make good decisions (Kahneman & Klein, 2009; Rogerson, Gottlieb,
Handelsman, Knapp, & Younggren, 2011). Physician Jerome Groopman
(2007) described the effect of thinking errors on physicians. For example, he
claimed that the premature foreclosure of oth