College of Social and Behavioral Sciences Arts and Sciences FISHER The APA Ethics Code and Ethical Decision Making T he APA’s Ethics Code provides a set of aspirational principles and behavioral rules written broadly to apply to psychologists’ varied roles and the diverse contexts in which the science and practice of psychology are conducted. The five aspirational principles described in Chapter 2 represent the core values of the discipline of psychology that guide members in recognizing in broad terms the moral rightness or wrongness of an act. As an articulation of the universal moral values intrinsic to the discipline, the aspirational principles are intended to inspire right action but do not specify what those actions might be. The ethical standards that will be discussed in later chapters of this book are concerned with specific behaviors that reflect the application of these moral principles to the work of psychologists in specific settings and with specific populations. In their everyday activities, psychologists will find many instances in which familiarity with and adherence to specific Ethical Standards provide adequate foundation for ethical actions. There will also be many instances in which (a) the means by which to comply with a standard are not readily apparent, (b) two seemingly competing standards appear equally appropriate, (c) application of a single standard or set of standards appears consistent with one aspirational principle but inconsistent with another, or (d) a judgment is required to determine if exemption criteria for a particular standard are met. The Ethics Code is not a formula for solving these ethical challenges. The Ethics Code provides psychologists with a set of aspirations and broad general rules of conduct that must be interpreted and applied as a function of the unique scientific and professional roles and relationships in which they are embedded. Psychologists are not moral technocrats simply working their way through a maze of ethical rules. Successful application of the principles and standards of the Ethics Code involves a conception of psychologists as active moral agents committed to the good and just practice and science of psychology. Ethical decision making thus involves a commitment to applying the Ethics Code to construct rather than simply discover solutions to ethical quandaries. This chapter discusses the ethical attitudes and decision-making strategies that can help psychologists prepare for, identify, and resolve ethical challenges as they continuously emerge and evolve in the dynamic discipline of psychology. An opportunity to apply these strategies is provided in the 10 case studies presented in Appendix B. Ethical Commitment and Virtues The development of a dynamic set of ethical standards for psychologists’ workrelated conduct 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. —APA (2010c, Preamble) Ethical commitment refers to a strong desire to do what is right because it is right (Josephson Institute of Ethics, 1999). In psychology, this commitment reflects a moral disposition and emotional responsiveness that move psychologists to creatively apply the APA’s Ethics Code principles and standards to the unique ethical demands of the scientific or professional context. The desire to do the right thing has often been associated with moral virtues or moral character, defined as a disposition to act and feel in accordance with moral principles, obligations, and ideals—a disposition that is neither principle bound nor situation specific (Beauchamp & Childress, 2001; MacIntyre, 1984). Virtues are dispositional habits acquired through social nurturance and professional education that provide psychologists with the motivation and skills necessary to apply the ideals and standards of the profession (see, e.g., Hauerwas, 1981; Jordan & Meara, 1990; May, 1984; National Academy of Sciences, 1995; Pellegrino, 1995). Fowers (2012) describes virtues as the cognitive, emotional, dispositional, behavioral, and wisdom aspects of character strength that motivates and enables us to act ethically out of an attachment to what is good. Focal Virtues for Psychology Many moral dispositions have been proposed for the virtuous professional (Beauchamp & Childress, 2001; Keenan, 1995; MacIntyre, 1984; May, 1984). For disciplines such as psychology, in which codes of conduct dictate the general parameters but not the context-specific nature of ethical conduct, conscientiousness, discernment, and prudence are requisite virtues. • • • A conscientious psychologist is motivated to do what is right because it is right, diligently tries to determine what is right, and makes reasonable attempts to do the right thing. A discerning psychologist brings contextually and relationally sensitive insight, good judgment, and appropriately detached understanding to determine what is right. A prudent psychologist applies practical wisdom to ethical challenges leading to right solutions that can be realized given the nature of the problem and the individuals involved. Some moral dispositions can be understood as derivative of their corresponding principles (Beauchamp & Childress, 2001). Drawing on the five APA General Principles, Table 3.1 lists corresponding virtues. The virtues considered most salient by members of a profession will vary with differences in role responsibilities. Benevolence, care, and compassion are often associated with the provision of mental health services. Prudence, discretion, and trustworthiness have been considered salient in scientific decision making. Scientists who willingly and consistently report procedures and findings accurately are enacting the virtue of honesty (Fowers, 2012). Fidelity, integrity, and wisdom are moral characteristics frequently associated with teaching and consultation. Across all work activities the virtue of “self-care” enables psychologists to maintain appropriate competencies under stressful work conditions (see the Hot Topic “The Ethical Component of Self-Care” at the end of this chapter. “Openness to the other” has been identified as a core virtue for the practice of multiculturalism (Fowers & Davidov, 2006). Openness is characterized by a personal and professional commitment to applying a multicultural lens to our work motivated by a genuine interest in understanding others rather than reacting to a new wave of multicultural “shoulds” (Gallardo, Johnson, Parham, & Carter, 2009). It reflects a strong desire to understand how culture is relevant to the identification and resolution of ethical challenges in research and practice, to explore cultural differences, to respond to fluid definitions of group characteristics, to recognize the realities of institutional racism and other forms of discrimination on personal identity and life opportunities, and to creatively apply the profession’s ethical principles and standards to each cultural context (Aronson, 2006; Fisher, in press; Fowers & Davidov, 2006; Hamilton & Mahalik, 2009; Neumark, 2009; Riggle, Rostosky, & Horne, 2010; D. W. Sue & Sue, 2003; Trimble, 2009; Trimble & Fisher, 2006). Table 3.1 APA Ethics Code General Principles and Corresponding Virtues APA General Principles Principle A: Nonmaleficence Beneficence Corresponding Virtues and Compassionate, and prudent humane, nonmalevolent, Principle B: Fidelity and Responsibility Faithful, dependable, and conscientious Principle C: Integrity Honest, reliable, and genuine Principle D: Justice Judicious and fair Principle E: Respect for People’s Rights Respectful and considerate and Dignity Can Virtues Be Taught? No course could automatically close the gap between knowing what is right and doing it. —Pellegrino (1989, p. 492) Some have argued that psychology professors cannot change graduate students’ moral character through classroom teaching, and therefore ethics education should focus on understanding the Ethics Code rather than instilling moral dispositions to right action. Without question, however, senior members of the discipline, through teaching and through their own examples, can enhance the ability of students and young professionals to understand the centrality of ethical commitment to ethical practice. At the same time, the development of professional moral character is not to simply know about virtue but to become good (P. A. Scott, 2003). Beyond the intellectual virtues transmitted in the classroom and modeled through mentoring and supervision, excellence of character can be acquired through habitual practice (Begley, 2006). One such habit is that the virtuous graduate student and seasoned psychologist are committed to lifelong learning and practice in the continued development of moral excellence. Ethical Awareness and Moral Principles In the process of making decisions regarding their professional behavior, psychologists must consider this Ethics Code, in addition to applicable laws and psychology board regulations. —APA (2010c, Introduction) Lack of awareness or misunderstanding of an ethical standard is not itself a defense to a charge of unethical conduct. —APA (2010c, Introduction) Ethical commitment is just the first step in effective ethical decision making. Good intentions are insufficient if psychologists fail to identify the ethical situations to which they should be applied. Psychologists found to have violated Ethical Standards or licensure regulations have too often harmed others or damaged their own careers or the careers of others because of ethical ignorance. Conscientious psychologists understand that identification of situations requiring ethical attention depends on familiarity and understanding of the APA Ethics Code, relevant scientific and professional guidelines, laws and regulations applicable to their specific work-related activities, and an awareness of relational obligations embedded within each context. Moral Principles and Ethical Awareness To identify a situation as warranting ethical consideration, psychologists must be aware of the moral values of the discipline. Although the Ethics Code’s General Principles are not exhaustive, they do identify the major moral ideals of psychology as a field. Familiarity with the General Principles, however, is not sufficient for good ethical decision making. Psychologists also need the knowledge, motivation, and coping skills to detect when situations call for consideration of these principles and attempt to address these issues when and if possible before they arise (Crowley & Gottlieb, 2012; Tjeltveit & Gottlieb, 2010; see also the Hot Topic “The Ethical Component of Self Care” at the end of this chapter). Table 3.2 identifies types of ethical awareness corresponding to each General Principle. Table 3.2 APA Ethics Code General Principles and the Ethical Awareness Necessary to Apply the Principles APA General Principles Corresponding Ethical Awareness Principle A: Beneficence and Nonmaleficence Psychologists should be able to identify what is in the best interests of those with whom they work, when a situation threatens the welfare of individuals, and the competencies required to achieve the greatest good and avoid or minimize harm. Principle B: Fidelity and Responsibility Psychologists should be aware of their obligations to the individuals and communities affected by their work, including their responsibilities to the profession and obligations under the law. Principle C: Integrity Psychologists should know what is possible before making professional commitments and be able to identify when it is necessary to correct misconceptions or mistrust. Principle D: Justice Psychologists should be able to identify individual or group vulnerabilities that can lead to exploitation and recognize when a course of action would result in or has resulted in unfair or unjust practices. Principle E: Respect for Psychologists must be aware of special safeguards necessary to People’s Rights and protect the autonomy, privacy, and dignity of members from the Dignity diverse populations with whom psychologists work. Ethical Awareness and Ethical Theories Ethical theories provide a moral framework to reflect on conflicting obligations. Unfortunately, ethical theories tend to emphasize one idea as the foundation for moral decision making, and illustrative problems are often reduced to that one idea. Given the complexity of moral reality, these frameworks are probably not mutually exclusive in their claims to moral truth (Steinbock, Arras, & London, 2003). However, awareness of the moral frameworks that might help address an ethical concern can also help clarify the values and available ethical choices (Beauchamp & Childress, 2001; Fisher, 1999; Kitchener, 1984). Deception Research: A Case Example for the Application of Different Ethical Theories Since Stanley Milgram (1963) published his well-known obedience experiments, the use of deception has become normative practice in some fields of psychological research and a frequent source of ethical debate (Baumrind, 1964, 1985; Fisher & Fyrberg, 1994). Deceptive techniques in research intentionally withhold information or misinform participants about the purpose of the study, the methodology, or roles of research confederates (Sieber, 1982). The methodological rationale for the use of deception is that some psychological phenomena cannot be adequately understood if research participants are aware of the purpose of the study. For example, deception has been used to study the phenomenon of “bystander apathy effect,” the tendency for people in the presence of others to observe but not help a person who is a victim of an attack, medical emergency, or other dangerous condition (Latane & Darley, 1970). In such experiments, false emergency situations are staged without the knowledge of the research participants, whose reactions to the “emergency” are recorded and analyzed. By its very nature, the use of deception in research creates what Fisher (2005a) has termed the consent paradox. On the one hand intentionally deceiving participants about the nature and purpose of a study conflicts with Principle C: Integrity and with enforceable standards requiring psychologists to obtain fully informed consent of research participants prior to study initiation. On the other hand by approximating naturalistic contexts in which everyday behaviors take place, the use of deception research can reflect Principle A: Beneficence and Nonmaleficence by enhancing the ability of psychologists to generate scientifically and socially useful knowledge that might not otherwise be obtained. Below are examples of how different ethical theories might lead to different conclusions about the moral acceptability of deception research. Readers should refer to Chapter 11 for a more in-depth discussion of Standard 8.07, Deception in Research. Deontology Deontology has been described as “absolutist,” “universal,” and “impersonal” (Kant, 1785/1959). It prioritizes absolute obligations over consequences. In this moral framework, ethical decision making is the rational act of applying universal principles to all situations irrespective of specific relationships, contexts, or consequences. This reflects Immanuel Kant’s conviction that ethical decisions cannot vary or be influenced by special circumstances or relationships. Rather, a decision is “moral” only if a rational person believes the act resulting from the decision should be universally followed in all situations. For Kant, respect for the worth of all persons was one such universal principle. A course of action that results in a person being used simply as a means for others’ gains would be ethically unacceptable. With respect to deception in research, from a deontological perspective, since we would not believe it moral to intentionally deceive individuals in some other context, neither potential benefits to society nor the effectiveness of participant debriefing for a particular deception study can morally justify intentionally deceiving persons about the purpose or nature of a research study. Further, deception in research would not be ethically permissible since intentionally disguising the nature of the study for the goals of research violates the moral obligation to respect each participant’s intrinsic worth by undermining individuals’ right to make rational and autonomous decisions regarding participation (Fisher & Fyrberg, 1994). Utilitarianism Utilitarian theory prioritizes the consequences (or utility) of an act over the application of universal principles (Mill, 1861/1957). From this perspective, an ethical decision is situation specific and must be governed by a risk–benefit calculus that determines which act will produce the greatest possible balance of good over bad consequences. An “act utilitarian” makes an ethical decision by evaluating the consequences of an act for a given situation. A “rule utilitarian” makes an ethical decision by evaluating whether following a general rule in all similar situations would create the greater good. Like deontology, utilitarianism is impersonal: It does not take into account interpersonal and relational features of ethical responsibility. From this perspective, psychologists’ obligations to those with whom they work can be superseded by an action that would produce a greater good for others (Fisher, 1999). A psychologist adhering to act utilitarianism might decide that the potential knowledge about social behavior generated by a specific deception study could produce benefits for many members of society, thereby justifying the minimal risk of harm and violation of autonomy rights for a few research participants. A rule utilitarian might decide against the use of deception in all research studies because the unknown benefits to society did not outweigh the potential harm to the discipline of psychology if society began to see it as an untrustworthy science. Communitarianism Communitarian theory assumes that right actions derive from community values, goals, traditions, and cooperative virtues. Accordingly, different populations with whom a psychologist works may require different conceptualizations of what is ethically appropriate (MacIntyre, 1989; Walzer, 1983). Unlike deontology, communitarianism rejects the elevation of individual over group rights. Whereas utilitarianism asks whether a policy will produce the greatest good for all individuals in society, communitarianism asks whether a policy will promote the kind of community we want to live in (Steinbock et al., 2003). Scientists as members of a community of shared values have traditionally assumed that (a) the pursuit of knowledge is a universal good and that (b) consideration for the practical consequences of research will inhibit scientific progress (Fisher, 1999; Sarason, 1984; Scarr, 1988). From this “community of scientists” perspective, the results of deception research are intrinsically valuable, and standards or regulations prohibiting deceptive research would deprive society of this knowledge. Thus, communitarian theory may be implicitly reflected, at least in part, in the acceptance of deception research in the APA Ethics Code (Standard 8.07, Deception in Research) and in current federal regulations (Department of Health and Human Services [DHHS], 2009) as representing the values of the scientific community. At the same time little is known about the extent to which the “community of research participants” shares the scientific community’s valuing of deception methods (Fisher & Fyrberg, 1994). Feminist Ethics Feminist ethics, or an ethics of care, sees emotional commitment to act on behalf of persons with whom one has a significant relationship as central to ethical decision making. This moral theory rejects the primacy of universal and individual rights in favor of relationally specific obligations (Baier, 1985; Brabeck, 2000; Fisher, 2000; Gilligan, 1982). Feminist ethics also focuses our attention on power imbalances and supports efforts to promote equality of power and opportunity. In evaluating the ethics of deception research, feminist psychologists might view intentional deception as a violation of interpersonal obligations of trust by investigators to participants and as reinforcing power inequities by permitting psychologists to deprive persons of information that might affect their decision to participate. Ethical Absolutism, Ethical Relativism, and Ethical Multiculturalism The movement known as multiculturalism is reshaping moral dialogue in psychology through its emphasis on inclusion, social justice, and mutual respect (Fowers & Davidov, 2006). Psychologists with high levels of ethical commitment and awareness are often stymied by moral complexities that surface when psychological activities are conducted in diverse contexts, cultures, or communities. For example, when applied to ethical decision making across different contexts, the universal perspective of the deontic position is indifferent to particular persons and situations. It therefore rejects the influence of culture on the identification and resolution of ethical problems in a manner that can lead to a one-size-fits-all form of ethical problem solving (Fisher, 1999). In sharp contrast, ethical relativism, often associated with some forms of utilitarianism and communitarianism, denies the existence of universal or common moral values characterizing the whole of human relationships, proposing instead that the identification and resolution of ethical problems are unique to each particular culture or community. Ethical contextualism (Fisher, 1999, 2000, in press; Macklin, 1999) blends the two approaches assuming that moral principles such as beneficence and respect for autonomy are universally valued across diverse contexts and cultures, but the expression of an ethical problem and the right actions to resolve it can be unique to the cultural context. From this perspective, universal moral principles can mediate our understanding of ethical meaning across diverse contexts without placing a priority on the principles themselves over the moral frameworks of others (Walker, 1992). Culture and Informed Consent: A Case Example Take the example of the ethical challenge of obtaining informed consent for mental health treatment for women suffering from posttraumatic stress disorder (PTSD) in wartorn countries where cultural mores require that permission is obtained from fathers, husbands, or brothers before a practitioner can offer services to women. A psychologist who is an ethical absolutist might refuse to obtain permission from a male relative prior to obtaining consent from a female living in this culture on the grounds that any action that privileges the opinion of a third party in a treatment or research decision is a violation of a universal principle of respect for individual autonomy. The cultural relativist, on the other hand, might interpret the cultural mores dictating male privilege as evidence that respect for individual autonomy is not a moral value in this particular culture; consequently, any action consistent with the cultural norm (e.g., obtaining the male relative’s permission) is ethical. The ethical contextualist would see the problem as one that requires consideration of both a universal valuing of individual autonomy and its traditional expression within this particular culture. A psychologist adopting this position would seek to resolve the ethical problem in a manner consistent with both. For example, examining the cultural meaning of this tradition, a psychologist might find that women in this culture value the male gatekeeper role and see it as beneficial to themselves and/or the stability of their families and communities. In this scenario, principles of justice and respect for personhood might result in an ethical resolution in which psychologists seek permission from a male relative before they obtain informed consent from potential female clients/patients—at the same time making it clear to both parties that the psychologist would respect the woman’s right to refuse treatment irrespective of male permission. Alternatively, the ethical contextualist might find that women living in this particular cultural community view this tradition as repressive and fear harsh retaliation if they disagree with the decision of their husbands or other male relatives. In this scenario, drawing on the principles of beneficence and nonmaleficence and respect for personhood, the psychologist might create a safe and confidential opportunity for women to learn about and then consent or refuse the treatment on their own without male involvement. For further discussion of these and related issues, readers are referred to the Hot Topics in Chapter 5, on multicultural ethical competence, and in Chapter 13, on the integration of religion and spirituality in therapy. Ethical Competence and Ethical Decision Making Too often, psychologists approach ethics as an afterthought to assessment or treatment plans, research designs, course preparation, or groundwork for forensic or consulting activities. Ethical planning based on familiarity with ethical standards, professional guidelines, state and federal laws, and organizational and institutional policies should be seen as integral rather than tangential to psychologists’ work. Ethical Knowledge and Planning Ethical Standards Familiarity with the rules of conduct set forth in the Ethical Standards enables psychologists to take preventive measures to avoid the harms, injustices, and violations of individual rights that often lead to ethical complaints. For example, psychologists familiar with the standards on confidentiality and disclosure discussed in Chapter 7 will take steps in advance to (a) develop appropriate procedures to protect the confidentiality of information obtained during their work-related activities; (b) appropriately inform research participants, clients/patients, organizational clients, and others in advance about the extent and limitations of confidentiality; and (c) develop specific plans and lists of appropriate professionals, agencies, and institutions to be used if disclosure of confidential information becomes necessary. Guidelines Good ethical planning also involves familiarity with guidelines for responsible practice and science. The APA and other professional and scientific organizations publish guidelines for responsible practice appropriate to particular psychological activities. Guidelines, unlike ethical standards, are essentially aspirational and unenforceable. As a result, compared with the enforceable Ethics Code standards, guidelines can include recommendations for and examples of responsible conduct with greater specificity to role, activity, and context. For example, Standard 2.01, Boundaries of Competence, requires psychologists to limit their services to populations and areas within their boundaries of competence, but as a general standard it does not specify what such competencies are in different work contents. By contrast, guidelines such as those for multicultural education, training, research, practice, and organizational change for psychologists (APA, 2003) describe the specific areas of training, education, or supervision that psychologists must have to perform their jobs competently. The Guidelines for Assessment of Dementia and Evaluation of Age-Related Cognitive Change (APA, 2012a) provides a list of necessary competencies, including memory changes associated with normative aging and the broad range of medical, pharmacological, and mental health disorders (e.g., depression) that can influence cognition in older adults. The crafters of guidelines developed by APA constituencies usually attempt to ensure that their recommendations are consistent with the most current APA Ethics Code—readers should be alert to instances in which the 2010 Ethics Code renders some guideline recommendations adopted prior to 2010 obsolete. Specific Guidelines are discussed throughout this book where their relevance to ethical standards can be applied. Laws, Regulations, and Policies Another important element of information gathering is identifying and understanding applicable laws, government regulations, and institutional and organizational policies that may dictate or limit specific courses of action necessary to resolve an ethical problem. There are state and federal laws and organizational policies governing patient privacy, mandated reporting, research with humans and animals, conduct among military enlistees and officers, employment discrimination, conflicts of interest, billing, and treatment. Psychologists involved in forensically relevant activities must also be familiar with rules of evidence governing expert testimony. Readers may wish to refer to the Hot Topic in Chapter 12 on the implications of case and federal law on the use of assessments in expert testimony. As discussed in Chapter 2, only a handful of Ethical Standards require psychologists to adhere to laws or institutional rules. However, choosing an ethical path that violates law, institutional rules, or company policy can have serious consequences for psychologists and others. Laws and policies should not dictate ethics, but familiarity with legal and organizational rules is essential for informed ethical decision making. When conflicts between ethics and law arise, psychologists consider the consequences of the decision for stakeholders, use practical wisdom to anticipate and take preventive actions for complications that can arise, and draw on professional virtues to help identify the moral principles most salient for meeting professional role obligations (Knapp, Gottlieb, Berman, & Handelsman, 2007). Stakeholders Ethical decision making requires sensitivity to and compassion for the views of individuals affected by actions taken. Discussions with stakeholders can clarify the multifaceted nature of an ethical problem, illuminate ethical principles that are in jeopardy of being violated or ignored, and alert psychologists to potential unintended consequences of specific action choices. By taking steps to understand the concerns, values, and perceptions of clients/patients, research participants, family members, organizational clients, students, IRBs or corporate compliance officers, and others with whom they work, psychologists can avoid ethical decisions that would be ineffective or harmful (Fisher, 1999, 2000). Steps in Ethical Decision Making Ethical commitment and well-informed ethical planning will reduce but not eliminate ethical challenges that emerge during the course of psychologists’ work. Ethical problems often arise when two or more principles or standards appear to be in conflict, in unexpected events, or in response to unforeseen reactions of those with whom a psychologist works. There is no ethical menu from which the right ethical actions simply can be selected. Many ethical challenges are unique in time, place, and persons involved. The very process of generating and evaluating alternative courses of action helps place in vivid relief the moral principles underlying such conflicts and stimulates creative strategies that may resolve or eliminate them. Ethical decisions are neither singular nor static. They involve a series of steps, each of which will be determined by the consequences of previous steps. Evaluation of alternative ethical solutions should take a narrative approach that sequentially considers the potential risks and benefits of each action. Understanding of relevant laws and regulations as well as the nature of institutions, companies, or organizations in which the activities will take place is similarly essential for adequate evaluation of the reactions and restraints imposed by the specific ethical context. A number of psychologists have proposed excellent ethical decision-making models to guide the responsible conduct of psychological science and practice (e.g., Barnett & Johnson, 2008; Canter et al., 1994; Kitchener, 1984; Koocher & Keith-Spiegel, 2008; Newman, Gray, & Fuqua, 1996; Rest, 1983; Staal & King, 2000). Drawing on these models and the importance of ethical commitment, awareness, and competence, an eightstep model is proposed: Step 1: Develop and sustain a professional commitment to doing what is right. Step 2: Acquire sufficient familiarity with the APA Ethics Code General Principles and Ethical Standards to be able to anticipate situations that require ethical planning and to identify unanticipated situations that require ethical decision making. Step 3: Gather additional facts relevant to the specific ethical situation from professional guidelines, state and federal laws, and organizational policies. Step 4: Make efforts to understand the perspective of different stakeholders who will be affected by the decision and consult with colleagues. Step 5: Apply Steps 1 to 4 to generate ethical alternatives and evaluate each alternative in terms of moral theories, General Principles and Ethical Standards, relevant laws and policies, and consequences to stakeholders. Step 6: Select and implement an ethical course of action. Step 7: Monitor and evaluate the effectiveness of the course of action. Step 8: Modify and continue to evaluate the ethical plan if feasible and necessary. Appendix B contains 10 case studies that provide readers with the opportunity to creatively apply to ethical challenges across a broad range of psychological work the ethical decision-making model described above and the knowledge they gain in reading chapters throughout this book. The next section provides an example of how the eight ethical decision-making steps can be applied to an ethical dilemma. An Example of Ethical Decision Making Dr. Ames conducts outpatient individual and group therapy for young adults with dual diagnosis (substance dependence and anxiety disorders). Although Dr. Ames was careful not to enter into the group those of her patients who were friends, partners, or relatives, she has recently learned that two group members (James and Angela) have started to date one another. In her next individual therapy session, Angela excitedly tells Dr. Ames that she is pregnant and is planning to move in with James, the father of her baby. When asked if she has seen a doctor, Angela replies that she does not have health insurance and has nothing to worry about since neither she nor James have any diseases. Dr. Ames knows from previous individual sessions with James that he is HIV positive. She asks Angela’s permission to speak with James about their new situation and Angela agrees. During his next session James tells Dr. Ames that he does not plan to tell Angela that he is HIV positive because she would leave him. He also angrily reminds Dr. Ames that she is “sworn to secrecy” because she promised that everything he told her, except child abuse or hurting someone, would be confidential. Step 1. Dr. Ames is committed to doing the right thing. She thinks of herself as honest, judicious, respectful, and compassionate. She struggles with her desire to maintain James’s confidentiality about his HIV status and her concern about the health risks to Angela and her pregnancy (Standards 2.01, Maintaining Confidentiality; 3.05, Avoiding Harm). Step 2. Dr. Ames reviews the Ethics Code standards. She realizes that because two of her group therapy patients have unexpectedly entered into a romantic relationship discussed only in their individual sessions that she is confronting an unforeseen potentially harmful multiple relationship (Standard 3.05b, Multiple Relationships). She realizes that her concerns regarding the health risks to Angela and her baby and her conflict over maintaining James’s confidentiality can potentially compromise her objectivity and effectiveness in performing her job. According to Standard 3.05b, she must take reasonable steps to resolve the problem with due regard for the best interests of all the affected persons. Dr. Ames also recognizes that while it is important to protect James’s confidentiality (Standard 4.01, Maintaining Confidentiality), the Ethics Code permits her to disclose confidential information to protect others from harm (Standard 4.05, Disclosures). She had thought that her informed consent procedure was consistent with ethical standards since she did inform James and all her individual and group clients/patients of her legal obligation to report child abuse and the possibility that disclosure could also occur to protect others from harm (Standard 4.02, Discussing the Limits of Confidentiality). However, although she was prepared to address issues of group members fraternizing outside of group, she had not anticipated that this type of situation would arise and she was unsure about the answers to the following questions. Should James’s decision to intentionally keep his HIV status secret and to continue to have unprotected sex with Angela be considered “harm” to another person? Did the consent language adequately inform Dr. Ames’s clients/patients that the risk of transmitting HIV would meet criteria for disclosure? Are there prohibitions in state law against revealing a nonmedical client’s/patient’s HIV status? Is exposing a fetus to HIV infection included in the legal definition of child abuse in Dr. Ames’s state? Dr. Ames also reviews the Ethics Code’s aspirational principles. She recognizes that she has a fiduciary responsibility to both James and Angela that rests on establishing relationships of trust (Principle B: Fidelity and Responsibility) and worries that the therapeutic alliance with James may be jeopardized if she discloses his HIV status to Angela and that her therapeutic alliance with Angela may be compromised if she is perceived to be colluding with James in a secret that could be harmful to the health of Angela and her baby (Principle A: Beneficence and Nonmaleficence, Principle C: Integrity, and Principle E: Respect for People’s Rights and Dignity). Step 3. Dr. Ames consults with legal counsel at her state psychological association and discovers that her state does not have a “duty to protect” law requiring clinicians to take steps to protect identified others from harm (see Chapter 7) and that mandatory child abuse–reporting laws are not extended to pregnancies. There are also no laws requiring or preventing mental health providers from disclosing information on HIV obtained in a nonmedical context. She reviews relevant publications and discovers that conditions requiring disclosure remain under debate within the discipline (Donner, VandeCreek, Gonsiorek, & Fisher, 2008). Step 4. She consults with medical colleagues regarding the probability that James will transmit the virus to Angela and the risks to her fetus and learns that infectivity rates are highly variable ranging from 1 per 1,000 to 1 per 3 contacts (Powers, Poole, Pettifor, & Cohen, 2008) and mother to child transmission is 15% to 30% occurring mostly in the last trimester (Orendi et al., 1999). She also speaks to the prenatal department of the community clinic and finds out that they routinely provide pregnant women with information regarding HIV risk protection. To ensure that she is sensitive to the cultural context from which James and Angela’s reactions to her decision may be embedded, she consults with her community advisory board (CAB) composed of former drug users and social service workers with experience serving this community. Some board members express the belief that the risk of HIV is well-known in the community and that Angela is responsible for protecting herself. Others believe that James is violating community standards and that he has therefore given away his right to confidentiality (see Fisher et al., 2009). Still, others point out that Dr. Ames may lose the trust of the rest of her group therapy members if she violates James’s confidentiality (Standard 10.03, Group Therapy). Through all of these discussions, Dr. Ames is careful not to reveal the identities of James and Angela (Standard 4.06, Consultations). Step 5. Dr. Ames begins to contemplate alternative actions. From a Kantian/deontic perspective, by not disclosing the HIV risk information to Angela, she would fulfill her confidentiality commitment to James, on which his autonomous consent to participate was based. At the same time, Kant’s idea of humanity as an end in itself might support taking steps to protect Angela and her fetus from harm. From a utilitarian perspective, the importance of protecting Angela and her fetus from a potentially life-threatening health risk must be weighed against the unknown probability of HIV infection to Angela and her fetus as well as Angela’s reaction to the disclosure. Dr. Ames also considers what type of decision would preserve the trust she has developed with her other group therapy clients/patients. The advisory board consultation suggested that there was not a broadly shared common moral perspective that would suggest a specific communitarian or multicultural approach to the problem. From a feminist ethics perspective, failing to disclose the information to Angela might perpetuate the powerlessness and victimization of women in this disenfranchised community. At the same time, disclosure might undermine Angela’s autonomy if in fact she is aware of HIV risk factors in general and knows or suspects James’s HIV positive status. Step 6. On the basis of the previous steps, Dr. Ames decides that she will not at this point disclose James’s HIV status to Angela. She concludes that her promise of confidentiality to James was explicitly related to his agreement to participate in treatment, while her sense of obligation to protect Angela from James’s behavior was not a requisite or an expectation of Angela’s participation. The community board’s comments suggest that Angela is most likely aware of the general risks of HIV transmission among drug users, as do some of Angela’s comments in Dr. Ames’s notes from previous sessions. In addition, Dr. Ames’s visit to the clinic indicated that there are community health services that routinely advise pregnant women about these risks and provide HIV testing. Dr. Ames decides that at her next individual session with Angela, and during subsequent sessions, she will encourage her to visit the free prenatal clinic, as well as discuss prenatal risks and the value of prenatal care. She will also tell James of her decision not to disclose his HIV status to Angela, continue to encourage him to do so, and provide him with written information regarding prenatal risk and safer sexual practices. Step 7. Dr. Ames will monitor and evaluate the effectiveness of her course of action. She will keep apprised of whether Angela visits the prenatal clinic, including whether Angela is tested for HIV. She will also monitor whether James begins to act in ways that will be protective of Angela, especially as Angela enters her third trimester. Dr. Ames will also continue to evaluate whether the unexpected multiple relationship with James and Angela compromises her ability to maintain objectivity in her individual and group sessions and seek consultation if necessary. Step 8. Whether or not monitoring over the next few months leads Dr. Ames to modify her decision to maintain James’s confidentiality, her evaluation of the effect of her course of action will influence her confidentiality and disclosure policies in the future. She plans to convene a meeting of community drug users and community practitioners to develop procedures that can anticipate and best address this type of issue in the future. Ethical decision making in psychology requires flexibility and sensitivity to the context, role responsibilities, and stakeholder expectations unique to each work endeavor. At their best, ethical choices reflect the reciprocal interplay between psychological activities and ethical standards in which each is continuously informed and transformed by the other. The specific manner in which the APA Ethics Code General Principles and Ethical Standards are applied should reflect a “goodness of fit” between ethical alternatives and the psychologist’s professional role, work setting, and stakeholder needs (Fisher, 2002b, 2003b; Fisher & Goodman, 2009; Fisher & Ragsdale, 2006; Masty & Fisher, 2008). Envisioning the responsible conduct of psychology as a process that draws on psychologists’ human responsiveness to those with whom they work and their awareness of their own boundaries, competencies, and obligations will sustain a profession that is both effective and ethical. Doing Good Well Ethics requires self-reflection and the courage to analyze and challenge one’s values and actions. Ethical practice is ensured only to the extent that there is a personal commitment accompanied by ethical awareness and active engagement in the ongoing construction, evaluation, and modification of ethical actions. In their commitment to the ongoing identification of key ethical crossroads and the construction of contextually sensitive ethical courses of action, psychologists reflect the highest ideals of the profession and merit the trust of those with whom they work. HOT TOPIC The Ethical Component of Self-Care The professional practice of psychology can be rewarding as well as stressful. Psychological treatment often involves working with clients/patients who express acute or chronic suicidality, engage in self-harm, are victims of abuse or assault, or are coping with the death of loved ones or with their own chronic or fatal disease. Clinicians treating veterans or others with posttraumatic stress disorder (PTSD) are regularly assessing and treating patients struggling with repetitive aggressive or homicidal episodes that may place the client/patient, their families, and the treating psychologist in physical danger (Voss Horrell, Holohan, Didion, & Vance, 2011). The Emotional Toll of Professional Practice The emotional toll and precarious nature of this work makes psychologists vulnerable to occupational stress, including emotional exhaustion, depersonalization and lack of personal accomplishment that lead to burnout, overcompensating efforts to “save” clients/patients or participants, boundary violations, and other behaviors that impair job performance (APA Committee on Colleague Assistance, 2006; Lee, Lim, Yang, & Lee, 2011; Webb, 2011). For example, military psychologists with extended deployments to war zones who are practicing in life-threatening contexts risk direct trauma-related distress and vicarious distress working with traumatized military personnel (W. B. Johnson et al., 2011). Psychologists working with patients or research participants graphically describing child or partner abuse, homelessness and hunger, drug abuse and violence, or death and dying may also experience vicarious or secondary trauma, guilt, or a sense of powerlessness for which there is little institutional support (McGourty, Farrants, Pratt, & Cankovic, 2010; Simmons & Koester, 2003). Psychologists who have a client/patient die from suicide, an accident, or fatal disease may not recognize or receive social support for their own grief reactions (Doka, 2008). Psychologists working in schools, military hospitals, or correctional facilities may experience the painful feelings and psychological disequilibrium that characterizes moral distress—lack of professional control to do what they believe is right (Corely, 2002) in response to institutional constraints on caseload, resources, use of evidence-based practices (EBPs), up-to-date assessment instruments, or trained personnel (Maltzman, 2011; O’Brien, 2011; Voss Horrell et al., 2011). Or in response to work-related stressors, psychologists may develop compassion fatigue or begin to process client/patient experiences on a purely cognitive level, a syndrome W. B. Johnson et al. (2011) describe as empathy failure. “Wounded Healer” Competent treatment of fatally ill, violent, or suicidal clients/patients may require extensive patient contact, behavioral monitoring, interactions with family members, and significant flexibility in identifying appropriate treatment strategies. Not surprisingly, many ethical dilemmas for psychologists working with these patients revolve around decisions regarding maintaining an appropriate balance between personal and professional boundaries (e.g., Standards 3.04, Avoiding Harm; 3.05, Multiple Relationships; 7.07, Sexual Relationships with Students and Supervisees; and 10.05, Sexual Intimacies with Current Therapy Clients/Patients). Working in emotionally charged therapeutic contexts can lead to work-related exhaustion, sense of urgency, and worries that may compromise competent therapeutic decisions (Standard 2.06, Personal Problems and Conflicts). On the other hand, such experiences can lead to unique professional growth. Jackson (2001) introduced the term wounded healer to describe how the emotional experience of working with such clients/patients can later serve to enhance psychologists’ therapeutic endeavors. Voss Horrell et al. (2011) have described similar positive developments in compassion satisfaction and posttraumatic growth in response to the challenges of treating veterans with PTSD. Mindfulness-Based Stress Reduction Research and clinical scholarship on the potential for and diminished work competence associated with burnout, social isolation, compassion fatigue, depression, and vicarious traumatization among psychologists working with high-risk populations have led to a widening endorsement of self-care practices as an essential ethical tool in ensuring competence in psychological work. Discerning when stress becomes impairment is difficult in the present moment (Barnett, 2008) and thus requires a proactive approach to self-care that mitigates the effect of stressors on professional competence (Tamura, 2012). One such approach is mindfulness-based stress reduction (MBSR; Kabat-Zinn, 1993) adapted for the practice of psychology. MBSR is rapidly becoming a popular approach for maintaining appropriate competencies under stressful work conditions. MBSR is a technique for enhancing emotional competence through attention to present moment inner experience without judgment. It is seen as an effective means of reducing emotional reactions toward and identification with clients’/patients’ problems that can lead to therapeutic deficits (Christopher & Maris, 2010; D. M. Davis & Hayes, 2011; S. L. Shapiro, Brown, & Biegel, 2007). Several recent studies have demonstrated positive effects of MBSR training on counseling skills and therapeutic relationships (Christopher, Christopher, Dunnagan, & Schure, 2006; McCollum & Gehart, 2010), including self-care educational materials in graduate courses and modeling and mentoring self-care habits in supervisory relationships. Practical Guidelines for Self-Care While there are empirical studies on effective approaches such as MBSR for maintaining and developing the competencies required, several psychologists have generously shared their own experiences and hardearned professional insights on personal and professional approaches to such challenging cases (Barnett, Cornish, Goodyear, & Lichtenberg, 2007; O’Brien, 2011; Tamura, 2012; Webb, 2011). Specific self-care strategies for competent practice include the following: • • • • • • Minimize risks posed by the social isolation of working in individualized therapeutic settings through formal (peer consultation or supervision) and informal (professional conferences, lunch with peers) activities Schedule activities that are not work related and develop daily strategies for transitioning from work life to home life Develop healthy habits of eating, sleeping, and exercise Set appropriate boundaries for work-related activities such as beginning and ending sessions on time, limiting work-related phone calls or e-mails to specific times of the day or early evening Diversify work activities and/or caseload Utilize personal psychotherapy as a means of addressing psychological distress and enhancing professional competence through increased self-awareness, self-monitoring, and emotional competence Preparing Psychology Trainees for Work-Related Risks and Self-Care Self-care strategies should be included in graduate education and training and encouraged as lifelong learning techniques (Barnett & Cooper, 2009). Trainees and young professionals may be particularly susceptible to stressors associated with clinical work, especially when programs have not provided training in self-awareness and self-regulation techniques to balance self and other interests and to maintain emotional competence (Andersson, King, & Lalande, 2010; S. L. Shapiro et al., 2007; Tamura, 2012). W. B. Johnson et al. (2011) propose that psychologists must acknowledge the ethical obligation to routinely assess their colleagues’ performance. This is especially important in graduate and internships programs in which students may rely on peer and faculty reactions as measures of their own competence. Programs should thus strive to create a culture of community competence that encourages trainees to recognize themselves as vulnerable to work-related stress and reduced competence, to recognize personal and professional dysfunction, and to develop professional self-care habits that support emotional and professional competence. Reference: Fisher, C. B. (20120904). Decoding the Ethics Code: A Practical Guide for Psychologists, 3rd Edition. 2.06 Personal Problems and Conflicts (a) Psychologists refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner. There is a growing body of research indicating that emotional, social, health-related, and other personal problems can interfere with psychologists’ ability to use their skills effectively. Substance abuse problems, acute depression or other mental disorders, chronic or life-threatening diseases, and other stressful life events such as divorce or the death of a loved one are situations that sometimes prevent psychologists from performing their work in a competent manner (W. B. Johnson & Barnett, 2011; O’Connor, 2001; Sherman & Thelen, 1998). Work-related stressors, such as social isolation in private practice, burnout, and vicarious traumatization encountered by some psychologists working with survivors of trauma, can lead to boundary violations and otherwise compromise effective job performance (Pearlman & Saakvitne, 1995; Skorupa & Agresti, 1993). Clients/patients, students, employers, and employees suffer when personal problems prevent psychologists from competently implementing their work, and the misconduct that is often a product of these circumstances harms public perceptions of psychology. Standard 2.06a requires psychologists to refrain from beginning an activity when there is a substantial likelihood their personal problems may impair their ability to perform their work competently. The phrases “refrain from beginning” and “substantial likelihood” indicate that the intent of this standard is preemptive: It prohibits psychologists from taking on a professional or scientific role when their personal problems have the potential to impair their work. As signified by the phrase “or should know,” psychologists suffering from problems that would reasonably be expected by members of the profession to cause work-related impairment will not avoid a finding of violation of this standard by claiming they did not know that their problems could interfere with their work. Pope and Brown (1996) note that competence in the conduct of psychotherapy requires knowledge of self-monitoring techniques to identify one’s own emotional strengths and weaknesses, needs and resources, and abilities and limits. Signs may include intense emotional reactions during therapy. A psychologist had just returned to independent practice following chemotherapy for a cancer that was now in remission. The psychologist believed that she had recovered from the fatigue and mental stress of the chemotherapy but recognized that such symptoms may persist. She set up a weekly consultation meeting with a colleague to help monitor her work until she was confident that the symptoms had fully abated. An industrial–organizational psychologist responsible for preemployment screening for an organization had begun to drink heavily and found that he needed to have several beers before seeing candidates in the morning and several more drinks periodically throughout the workday. In response to a complaint to the APA Ethics Committee filed by an applicant who was appalled by the psychologist’s slurring of words during a screening, the psychologist claimed that his alcoholism prevented him from acknowledging he had a problem. Strategies for Preventing Work-Related Stress Involving High-Risk Clients/Patients Kristen Webb (2011) addressed the ethical dilemma of providing consistent and reliable care to a patient with suicidal urges, self-harming behaviors, and significant abandonment issues with the need to ensure competent provision of services in formal sessions and telephone contact. She scheduled brief (8minute) regular telephone check-ins between sessions to assure the patient of her availability to assist with life-threatening urges, but she limited these phone calls to skills coaching. She adhered to firm boundaries for beginning and ending sessions. Webb carefully used self-disclosure to provide the patient with examples of how she had weathered storms in her life, consistently monitoring the effect of the disclosures on her patient and the therapeutic (vs. countertransferential) motivation for the disclosures, and sought regular peer consultation. She was alert to feelings of professional discouragement, physical exhaustion, and stress related to fears of a poor outcome for her patient. She monitored her sleep and eating, created transitional activities between work and home, and made time to set aside her worries and counter the self-isolation that therapists can experience through self-nourishing exercise and socializing. Readers may also wish to refer to the Hot Topic in Chapter 3 on the ethics of self-care. (b) When psychologists become aware of personal problems that may interfere with their performing work-related duties adequately, they take appropriate measures, such as obtaining professional consultation or assistance, and determine whether they should limit, suspend, or terminate their work-related duties. (See also Standard 10.10, Terminating Therapy.) Standard 2.06b applies to situations in which psychologists who are already providing services, teaching, or conducting research become aware that their personal problems are interfering with their work. The standard calls for psychologists to take appropriate steps to remedy the problem and to determine whether such remedies are sufficient for them to continue work-related activities. A teaching psychologist who was undergoing outpatient treatment for a lifethreatening medical disorder found it increasingly difficult to prepare lectures, grade papers, and mentor students effectively. The psychologist consulted with the chair of the department, who agreed to assign an experienced graduate teaching assistant for the lectures. The psychologist also asked a colleague to serve as a consultant on the two dissertations he was currently mentoring. Distinguishing between personal and professional impairment is not always easy, nor is there consensus among members of the profession on how to identify work-related impairment (P. L. Smith & Burton Moss, 2009; Williams, Pomerantz, Segrist, & Pettibone, 2010). Fear of losing highly valued abilities in the face of serious, chronic, or life-threatening diseases or being judged by colleagues as incompetent can create denial and professional blind spots (Barnett, 2008). Health problems and personal distress become professional deficits when they make services ineffective or compromise functioning in ways that harm students, research participants, organizational clients, and patients (Munsey, 2006). Signs of impairment may include intense emotional reactions (e.g., anger or uncontrolled sexual attraction), disrespectful comments to clients/patients or students, lack of energy or interest in work, or using work to block out negative personal feelings to the detriment of those with whom one works (Pope & Vasquez, 2007; P. L. Smith & Burton Moss, 2009). To comply with this standard, psychologists can turn to the increasing number of state licensing boards and state psychological associations that provide colleague assistance programs to help psychologists deal proactively with and remediate impairment (APA Committee on Colleague Assistance, 2006; Barnett & Hillard, 2001). If such steps are not adequate to ensure competence, Standard 2.06a requires that psychologists appropriately limit, suspend, or terminate work-related duties. A counseling psychologist returned to her position at a college counseling center after sick leave for physical injuries incurred during a car accident. Within a week at the counseling center, the psychologist realized the pain medication she was frequently taking during the day was interfering with her ability to focus on clients’ problems. She contacted a psychologist assistance program in her state that helped her taper off the medications, provided ongoing supervision to help her self-monitor her ability to perform her tasks, and provided support for the psychologist to approach the director of the counseling center to cut back on her hours. A psychologist working in a correctional facility was violently attacked by a new prisoner during a psychological assessment interview. The psychologist did not seek psychological counseling for his reaction to the assault. A month later, the psychologist was conducting an intake of a prisoner who reminded him of his attacker. Although the psychological assessment did not provide evidence of extreme dangerousness, the psychologist’s report indicated the prisoner was highly dangerous and should be assigned to the most restrictive environment (adapted from Weinberger & Sreenivasan, 2003). Need to Know: Education and Training Stressors Graduate students are also vulnerable to stressful life experiences, physical or mental illness, and substance use problems. In addition, graduate schools and postdoctoral internships or research can create distress related to financial concerns, relocation, lack of social support, and academic and related time pressures (APA, Committee on Colleague Assistance, 2006; Tamura, 2012). Education and training programs can increase the competent conduct of practice and research by providing (a) materials on how personal problems can diminish professional competence; (b) strategies for assessing and monitoring when these problems may compromise effectiveness and harm those with whom they work; (c) opportunities to openly discuss these issues with faculty and supervisors; and (d) fair and effective approaches to remediation and, if necessary, termination, when a student exhibits signs of impairment (N. J. Kaslow, et al., 2007; Tamura, 2012; see also Hot Topic “The Ethical Component of Self-Care” in Chapter 3). HOT TOPIC Multicultural Ethical Competence Ethical decision making for psychological research and practice in diverse cultural venues must be sensitive to cultural attitudes toward individual autonomy and communal responsibility, historical and contemporary discrimination within society and psychology as a discipline, sociopolitical factors influencing definitions of race and ethnicity, and variations in immigration history, acculturation, cultural/ethnic identity, language, and mixed race/ethnic heritage (Arrendo & Toporek, 2004; Fisher et al., 2002; Fisher et al., 2012; Fisher, in press; Lyon & Cotler, 2007; Ponterotto, Casas, Suzuki, & Alexander, 2001; D. W. Sue & Sue, 2003; Trimble & Fisher, 2006). Multicultural responsibility requires “a fusion of personal and professional commitments to consider culture during ethical encounters” (Ridley et al., 2001, p. 176). This Hot Topic section applies the ethical decision-making model introduced in Chapter 3 to help psychologists identify key questions to consider as a means of acquiring the attitudes and knowledge essential to multicultural ethical competence. Multicultural Ethical Commitment Multicultural ethical commitment requires a strong desire to understand how culture is relevant to the identification and resolution of ethical problems. It demands a moral disposition and emotional responsiveness that moves psychologists to explore cultural differences and creatively apply the APA Ethics Code to each cultural context. Cultivation of these competencies thus includes motivation to consider the influence of culture in psychologists’ work conscientiously, prudently, and with caring discernment. The desire to ensure that cultural sensitivity is integrated into ethical decision making requires a willingness to reflect on how one’s own cultural values and cultural identity influence the way ethics is conceived in one’s activities as a psychologist (Arredondo, 1999; Helms, 1993; Trimble, Trickett, Fisher, & Goodyear, 2012). Furthermore, multicultural ethical competence entails recognition of harms that psychology can exert on culturally diverse groups by invalidating their life experiences, defining their cultural values or differences as deviant, and imposing the values of dominant culture upon them (Fisher, 1999; Fisher et al., 2002; Fowers & Davidov, 2006; Prilleltensky, 1997; Trimble & Fisher, 2006; Vasquez, 2012). In psychological research and practice, multicultural ethical commitment involves motivation to do the following: • • • • Critically examine moral premises in the discipline that may largely reflect Eurocentric conceptions of the good Question “deficit” and “ethnic group comparative” approaches to understanding cultural differences Address the reality and impact of racial discrimination in the lives of cultural minorities Recognize that socially constructed racial/ethnic labels can strip participants of their personal identity by responding to them only in terms of racial or ethnic categorizations • • • Avoid conceptually grouping members of ethnic minority groups into categories that may not reflect how individuals see themselves Engage in self-examination of how institutional racism may have influenced each psychologist’s own role, status, and motivation to develop professional identities free from these influences Develop the flexibility required to respond to rapid cultural diversification and fluid definitions of culture, ethnicity, and race Multicultural Ethical Awareness Multicultural ethical commitment is just the first step toward multicultural ethical competence. Good intentions are insufficient if psychologists fail to acquire relevant knowledge about cultural differences and how they may affect the expression of and solutions for ethical problems. To ethically work with diverse populations, psychologists must remain up-to-date on advances in multicultural research, theory, and practice guidelines relevant to their work (Salter & Salter, 2012). This may include an understanding of the following: • • • • • • • • The history of ethical abuses of cultural minorities in the United States, and how this may exacerbate disparities in mental health care, employment, criminal justice, and involvement in psychological research The impact on mental health of historical and contemporary discrimination in employment, education, housing, and other areas Cultural and contextual factors that may facilitate or interfere with psychological well-being or responsiveness to treatment Scientific, social, and political factors influencing the definitions of race, ethnicity, and culture, and how these may serve as barriers to conducting psychological activities that protect individuals’ rights and welfare Within-group as well as between-group differences that may be obscured by cultural stereotypes in society and within the discipline of psychology Knowledge and skills in constructing and implementing culturally valid and language-appropriate assessments, treatments, research procedures, teaching strategies, and consulting and organizational evaluation techniques Knowledge of relevant ethical standards in the APA Ethics Code and organizational guidelines relevant to multicultural ethical competence in research and practice Knowledge of antidiscrimination federal and state laws relevant to the contexts in which psychologists work Goodness-of-Fit Ethics and Multicultural Ethical Decision Making Multicultural ethical commitment and ethical awareness are essential but not sufficient to ensure ethical resolution of multicultural challenges. Given the dynamic nature of individual, institutional, and sociopolitical concepts of race, culture, and ethnicity, ethical decision making across different cultural contexts can be informed but may not be resolved by previous approaches to ethical problems. Many multicultural ethical challenges are unique to the culture, the salience of the culture for a particular individual in a particular context, other within-culture individual differences, the environment in which the psychological activity occurs, and the goals of that activity (Nicolaidis et al., 2010). In applying the steps for ethical decision making described in Chapter 3, multicultural ethical competence includes (a) creating a goodness of fit between the cultural context and the psychologist’s work setting and goals and (b) engaging in a process of co-learning that ensures this fit (Fisher, 1999, 2002a, in press; Fisher & Goodman, 2009; Fisher & Masty, 2006; Fisher & Ragsdale, 2006; Fisher et al., 2012; Trimble, Trickett, Fisher, & Goodyear, 2012). Applying goodness-of-fit ethics to multicultural contexts requires reflection on the following questions: • • • • • • • What are the cultural circumstances that might render individuals more susceptible to the benefits or risks of the intended psychological assessment, treatment, or research? Are cultural factors under- or overestimated in the assessment, treatment, organizational evaluation, or research plan? Do psychologists and members of cultural groups with whom they work have different conceptions of practice goals or research benefits? Are traditional approaches to informed consent and confidentiality protections compatible with the values of spirit, collectivity, and harmony characteristic of different ethnocultural populations? Are there aspects of the psychological work setting that are “misfitted” to the competencies, values, fears, and hopes of recipients of psychological services, examinees, employees, or research participants? How can the setting (including the aims and procedures to accomplish these aims) be modified to fit the requirements of culturally sensitive and responsibly conducted psychology? How can psychologists engage organizations and employees, clients/patients and practitioners, students and school personnel, research participants, and investigators in discussions that will help illuminate the cultural lens through which each views the psychologist’s work? Culture is a dynamic construct influenced by an ever-changing sociopolitical landscape. Ethical decision making that includes multicultural commitment and awareness can help psychologists correct cultural misimpressions and biases in their work. An openness to learning from and collaborating with stakeholders can help psychologists implement and monitor the cultural adequacy of ethical decisions and make appropriate adjustments when necessary. Multicultural ethical competence requires a process of lifelong learning that enables psychologists to make ethical decisions that reflect and respect the values of the discipline of psychology and the values of cultural communities. Canadian Psychology / Psychologie canadienne 2017, Vol. 58, No. 2, 87–104 © 2016 Canadian Psychological Association 0708-5591/17/$12.00 http://dx.doi.org/10.1037/cap0000063 Findings All Psychologists Should Know From the New Science on Subjective Well-Being Ed Diener Samantha J. Heintzelman and Kostadin Kushlev University of Virginia and University of Utah University of Virginia Louis Tay Derrick Wirtz and Lesley D. Lutes Purdue University University of British Columbia Shigehiro Oishi University of Virginia Recent decades have seen rapid growth in the science of subjective well-being (SWB), with 14,000 publications a year now broaching the topic. The insights of this growing scholarly literature can be helpful to psychologists working both in research and applied areas. The authors describe 5 sets of recent findings on SWB: (a) the multidimensionality of SWB; (b) circumstances that influence long-term SWB; (c) cultural differences in SWB; (d) the beneficial effects of SWB on health and social relationships; and (e) interventions to increase SWB. In addition, they outline the implications of these findings for the helping professions, organizational psychology, and for researchers. Finally, they describe current developments in national accounts of well-being, which capture the quality of life in societies beyond economic indicators and point toward policies that can enhance societal well-being. Keywords: subjective well-being, happiness, organizational behavior, clinical psychology, culture implications for practice in various fields. We focus on recent findings that have broad implications for scholars and researchers, as well as for practitioners, including clinical, counselling, and organizational psychologists. The senior author began studying subjective well-being (SWB) over three decades ago with his first review of SWB appearing in Psychological Bulletin (Diener, 1984). At that time only a few publications a year were published on SWB. Today, a Google Scholar search for subjective well-being reveals that there are over 140,000 articles that have touched on this topic; in 2015 alone, there were over 14,000 publications that mentioned SWB. The field has become vibrant and has attracted diverse scholars from psychology, economics, political science, sociology, and anthropology. Advances in the field range from cross-cultural differences in what causes SWB to developmental trajectories of SWB over the life course. And the insights of this science of SWB are increasingly being used to understand clinical phenomena, organizational outcomes, and societal quality of life. A psychologist recently asked the senior author, “Who cares about life satisfaction? Why does it matter?” This article is meant to answer these questions by reviewing key findings about life satisfaction and other forms of SWB, and by elucidating the Defining and Assessing SWB SWB is defined as people’s overall evaluations of their lives and their emotional experiences. SWB thus includes broad appraisals, such as life satisfaction and health satisfaction judgments, and specific feelings that reflect how people are reacting to the events and circumstances in their lives. Indeed, it has become abundantly clear over the last few decades that SWB is not a single unitary entity. Yet, there has been some confusion about terminology. Happiness is a loose term with many meanings and so is often avoided in the scientific literature. SWB, on the other hand, is a broad umbrella term that refers to all different forms of evaluating one’s life or emotional experience, such as satisfaction, positive affect (PA), and low negative affect (NA) (see Diener, Oishi, & Lucas, 2016). The facets of SWB are separable in factor analyses and have distinctive associations with other variables. Thus, they should be assessed individually. Life satisfaction, for example, can be assessed with self-report measures such as the Satisfaction with Life Scale (SWLS; Diener, Emmons, Larsen, & Griffin, 1985) or with even single-item measures (e.g., Cantril, 1965). PA includes the person’s desirable or pleasant emotions, such as enjoyment, gratitude, and contentment; PA can be assessed with self-report scales such as the Positive and Negative Affect Schedule (PANAS; Watson, Clark, & Tellegen, 1988) or the Scale of Positive and This article was published Online First October 6, 2016. Ed Diener, Department of Psychology, University of Virginia and University of Utah; Samantha J. Heintzelman and Kostadin Kushlev, Department of Psychology, University of Virginia; Louis Tay, Department of Psychology, Purdue University; Derrick Wirtz and Lesley D. Lutes, Department of Psychology, University of British Columbia; Shigehiro Oishi, University of Virginia. Correspondence concerning this article should be addressed to Ed Diener, Department of Psychology, University of Virginia, PO Box 400400, Charlottesville, VA, 22904. E-mail: ediener@illinois.edu 87 88 DIENER ET AL. Negative Experience (SPANE; Diener, Wirtz, et al., 2010). These same scales also assess NA, such as anger, sadness, and worry. Extensive research validates the above scales of SWB (e.g., Diener, Inglehart, & Tay, 2013). The scales correlate with other measures assessing the same concept, predict future behavior such as suicide, and correlate with nonself-report measures of wellbeing such as those based on informant reports or behavior. These measures of SWB also predict other closely related constructs, such as social support and meaning in life that, strictly speaking, are not considered aspects of SWB (e.g., Su, Tay, & Diener, 2014). Furthermore, researchers have begun to elucidate the processes involved in responding to the scales of SWB, as well as the biases that can affect scores on the SWB scales (see Diener et al., 2016). Not only are the facets of SWB found to be separable when the measures are factor-analyzed, but they are also separable in terms of what influences them, and what they, in turn, influence. For example, positive emotions seem to be influenced by social relationships (Tay & Diener, 2011), and in turn they seem to raise sociability (Berry & Hansen, 1996). In contrast, negative emotions seem most related to internal and social conflicts (Stoeva, Chiu, & Greenhaus, 2002) and the perception of problems (Watson, 1998). Life satisfaction seems to be heavily influenced by factors that are chronically accessible in systematically evaluating one’s life (Schimmack & Oishi, 2005), such as health, income, and the quality of one’s work. As compared to feelings, life satisfaction is more closely related to income at both the individual and nation levels (Diener, Tay, & Oishi, 2013; Kahneman & Deaton, 2010). These findings indicate that we cannot obtain a full assessment of SWB by simply measuring one facet of this larger construct; several components must be measured to provide a rounded account of SWB. Implications for Clinical and Counselling Psychologists Defining and conceptualizing SWB as multidimensional has important implications for clinical and counselling psychologists. Increasingly, individuals are pursuing therapy with the goal of living a more complete, fulfilling, or satisfying life (Lent, 2004) and understanding the structure of SWB can help practitioners assist patients in achieving these goals. Clinicians can benefit from a nuanced assessment of the cognitive and affective facets of SWB, with their distinct causes and consequences, and can seamlessly move into evidence-based interventions designed to affect one or more of these dimensions as is relevant to an individual’s goals. Understanding the multidimensionality of SWB and using the brief, freely accessible, validated SWB measures we have presented here as a complement to common clinical assessment measures can also aid in the identification and treatment of a range of psychological disorders. Depression, for example, entails both the presence of NA and lack of PA, yet existing depression assessments focus on NA. Differentiating aspects of SWB can also help to distinguish between psychological disorders. For example, depression and anxiety disorders both feature NA, yet are differentiated in terms of PA, with a deficit in PA more characteristic of depression than most anxiety disorders (Stanton & Watson, 2014). Understanding the multidimensionality of SWB can thus provide insight into effective paths to treatment, perhaps leading to improvements in patient outcomes. Implications for Organizational Psychologists The field of organizational psychology has traditionally been interested in SWB. The idea that SWB is nonunitary and requires different assessments in this field has been recognized. SWB is conceptualized in domain-specific ways (e.g., job satisfaction rather than life satisfaction) and/or broken down into more discrete states (e.g., stress/anxiety rather than NA). Two perspectives have made contributions to organizational scholarship on SWB. First, the realm of job attitudes emphasizes cognitive and affective components (Hulin & Judge, 2003) by assessing job satisfaction and feelings toward one’s job, respectively. Job attitudes are useful evaluative indicators of work experience and the quality of the work environment (Freeman, 1978; Herzberg, 1966). Second, occupational stress research focuses on negative aspects of affective SWB, such as stress and anxiety (e.g., Karasek, 1979). This research stemmed from a desire to reduce ailments and mistreatments in the workplace. Moving beyond these early workplace research perspectives, contemporary perspectives within organizational science highlight the centrality of the worker and his or her experiences in addition to organizational goals and needs (Weiss & Rupp, 2011). This led to incorporating nonwork SWB in assessments of employee wellbeing. As a result, life satisfaction of workers is recognized as an important work factor, both influencing and being influenced by the work experience (Erdogan, Bauer, Truxillo, & Mansfield, 2012). Similarly, research on nonwork domains such as leisure satisfaction (Kuykendall, Tay, & Ng, 2015) and relationship satisfaction (Cho & Tay, 2016) has increasingly been brought to the fore. These developments have further been fostered by recognition of the permeability of work and nonwork domains. Organizational psychologists have also begun to study daily feelings that spill over into and extend beyond work (Weiss & Cropanzano, 1996), with an added inclusion of more positive feelings. Organizations now recognize that worker SWB needs to be holistically assessed using multiple indicators. There is attention placed on ameliorating stress in workers as high negativity leads to health problems in the long run. There is also a desire to keep workers satisfied with their work in order to enhance job performance. This has led to increasing the level of autonomy given to workers and implementing job rotations to provide continued interest and engagement at work. Moreover, businesses are now trying to accommodate more flexible work plans in order to enhance the satisfaction of talented people in nonwork life domains such as family and leisure. Thus, the goal of improving worker SWB has already led to many changes in the workplace. Future research revealing additional predictors and outcomes of different types of SWB will contribute to a better workplace. Implications for Research Psychologists Because research has established separable facets of SWB, we advise scholars looking at the causes and consequences of wellbeing to take a nuanced approach to conceptualizing and assessing each SWB component. Currently, research studies may focus on only one or two facets of SWB, yet authors often discuss SWB in general terms. In addition, to reliably assess the causes and consequences of each aspect of SWB, we recommend the use of large samples and diverse measures. With small samples, any observed differences SUBJECTIVE WELL-BEING could be due to chance and require replication; findings based on small samples, therefore, should be interpreted with caution. Currently, the number of studies with large representative samples is growing, and we are beginning to uncover what reliably leads to life satisfaction versus positive or negative feelings. However, a substantial amount of work still needs to be done to ensure reproducibility and to confirm that results are not due to the use of specific measures; and more work needs to be conducted on narrower aspects of SWB (e.g., job satisfaction, joy, contentment). Furthermore, we recommend that researchers use statistical methods where multiple aspects of SWB are assessed to parse SWB into common, unique, and error variance (e.g., bifactor models). This enables us to more cleanly delineate aspects of SWB (e.g., different domain satisfactions vs. global SWB) and their relation to specific causes/outcomes. Although there are instances where one component of SWB has been found to correlate with other variables more strongly than another component of SWB, the sample sizes and analyses are usually not adequate to fully confirm the conclusions. In short, despite the significant progress in the measurement of SWB in the past several decades, more research with sound statistical methodology is necessary to fully elucidate the structure, causes, and consequences of SWB. SWB Is Influenced by Situations and Circumstances After an initial focus in the field on the demographic predictors of SWB came an emphasis on genes, temperament, and personality as major causes—and perhaps the only long-term causes— of SWB. The claim that people adapt to conditions, both bad and good, over time (Brickman & Campbell, 1971; Brickman, Coates, & Janoff-Bulman, 1978) became a widespread belief. The authors suggested that we are on a running wheel, charging ahead to get happier, but with no actual progress. Next came the claim that levels of long-term SWB can be explained entirely by genes (Lykken & Tellegen, 1996). However, recent evidence on genetic heritability has produced somewhat lower heritability estimates than were initially suggested. In a meta-analysis of 13 studies, Nes and Roysamb (2015) found an average heritability of .40, and much variability between studies. It is worthwhile to note that this indicates that 40% of variability in SWB is accounted by genes but there is still the remaining 60% that is not. Importantly, heritability figures do not directly point to how much a trait can be altered by individual choices or the environment (Roysamb, Nes, & Vitterso, 2014). Heritability is not a fixed constant; rather, it is influenced by the amount of variability in the environment. In homogeneous environments heritabilities are likely to be higher compared to societies where the environment varies more across individuals. Furthermore, even factors that are highly heritable, such as height or hair color, can be influenced by environmental factors, such as diet or hair-coloring. Similarly, heritability estimates do not indicate that circumstances will not influence SWB. Recent findings on adaptation provide further evidence against the idea that circumstances do not matter for SWB. We now know that events do influence people’s SWB, and despite adaptation in some cases these changes are often permanent or last for many years (Lucas, 2007). In long-term longitudinal studies, for example, a significant proportion of respondents show changes in their levels of SWB over time (Fujita & Diener, 2005). In a meta- 89 analysis of prospective longitudinal studies, Luhmann and colleagues (2012) found that changes in circumstances, including marriage and unemployment, continued to influence both life satisfaction and affective well-being long after they occurred. Similarly, Anusic, Yap, and Lucas (2014) found that people did not always fully adapt to events, such as unemployment and disability. Furthermore, some studies show “scarring,” in which an unfortunate event continues to affect SWB even after it is remedied. Even after re-employment, for example, previously unemployed people do not always return to their pre-unemployment levels of SWB (Clark, Georgellis, & Sanfey, 2001). Evidence showing large societal differences in SWB also point to the importance of circumstances for SWB. In some cases, the differences in SWB between societies—Zimbabwe versus Denmark or Togo versus Canada— can cover almost half of the total range of the scale. Inborn temperament seems an unlikely explanation for these huge national differences in SWB. Indeed, these nation-level differences are in part explained by factors such as income, the rule of law, and income inequality rather than temperament or heritability (Diener, Diener, & Diener, 1995; Oishi, Kesebir, & Diener, 2011). In sum, research increasingly shows that SWB is malleable at both the individual and societal level (Tay & Kuykendall, 2013). Thus, it has become abundantly clear that circumstances and the choices people make in life can, and do, influence their long-term SWB. We are no longer stuck with the fatalistic idea that nothing can be done to improve human SWB. Implications for Clinical and Counselling Psychologists The notion of SWB as a product of both innate factors and modifiable cognitions and behaviors is consistent with the biopsychosocial model (Engel, 1980) commonly recognized by clinical and counselling psychologists. The growing appreciation of individual circumstances, cognitions, and behaviors as important determinants of SWB suggests that clinical and counselling psychology can be influential in the promotion of SWB. The tools of cognitive– behavioural therapy, such as identifying maladaptive thoughts and behaviors, and working with patients or clients to establish alternative ones, can be directly applied to the improvement of SWB. As one example, consider the importance of social relationships to the experience of positive emotions (Tay & Diener, 2011). Techniques developed for use in therapeutic contexts, such as social skills training, offer the potential to learn new behaviors that will, via the enhancement of social relationships, also positively influence an individual’s SWB. Importantly, the goal of such clinical techniques (i.e., cognitive restructuring) is not to develop a naïvely positive or rosy view of the world, but to facilitate a realistic and balanced perspective in accord with a patient’s desire for greater SWB and personal growth. In short, the recognition by clinicians that cognitive, affective, and behavioral patterns are malleable dovetails with emerging research in SWB and suggests techniques for improving SWB. Implications for Organizational Psychologists Situational influences also have a significant bearing on workrelated SWB. The estimated contribution of genetic factors to job 90 DIENER ET AL. satisfaction is .30 (Arvey, Bouchard, Segal, & Abraham, 1989)— lower than the heritability factors of life satisfaction. This suggests that the type of work and the work environment may be particularly important for SWB at work. Compensation is one situational factor that influences job satisfaction. The relation between salary and job satisfaction, however, is small (meta-analytic r ⫽ .15; Judge, Piccolo, Podsakoff, Shaw, & Rich, 2010), even when compared to the relatively small influence of income on general life satisfaction (Howell & Howell, 2008). This finding highlights the role of other aspects of work in job-related SWB. Indeed, job characteristics that fulfill psychological needs such as meaning, autonomy, and a sense of competence (Hackman & Oldham, 1976) are substantially associated with job satisfaction. Moreover, active crafting of work to fit workers’ needs, as well as their abilities and preferences, also produces higher levels of job satisfaction (Tims, Bakker, & Derks, 2013; Wrzeniewski & Dutton, 2001). Finally, flexibility at work to accommodate other nonwork demands (e.g., marriage and children) also significantly predicts greater job satisfaction (Scandura & Lankau, 1997). The work context is also critical for fostering greater SWB. On the negative end, a climate of sexual harassment or ongoing stress lowers job satisfaction and increases work withdrawal and burnout (Fitzgerald, Drasgow, Hulin, Gelfand, & Magley, 1997; Schaefer & Moos, 1996). On the positive end, worker perceptions of a positive work climate promote higher job satisfaction (Parker et al., 2003). Such climates can be fostered through leadership and organizational policies. Supervisor interactions and supportiveness are key predictors of positive job attitudes. Indeed, unsupportive leaders create greater distress, work-family conflict, and job dissatisfaction among supervisees (Mathieu, Neumann, Hare, & Babiak, 2014). Similarly, organizational policies that attend to the needs of employees—such as the provision of flexible schedules and dependent services for workers with dependents—lower depression and job dissatisfaction among employees (Thomas & Ganster, 1995). National economic factors can also influence job satisfaction among workers. Beyond job optimism and national wealth, lower national unemployment rates predict higher job satisfaction across 136 nations (Tay & Harter, 2013). Across Europe, nations with higher wage levels (and wage-to-effort ratios) have higher levels of job satisfaction (Pichler & Wallace, 2009; Sousa-Poza & SousaPoza, 2000). In conclusion, there is now evidence linking worker SWB to controllable organizational and economic factors. Organizations can enhance job benefits/flexibility, promote positive leadership practices, and cultivate an inclusive work climate to enhance SWB. National economic policies that focus on job creation will impinge on national worker SWB as well. Implications for Research Psychologists An important goal for future research investigating the effects of circumstances on SWB is to determine when people adapt to their circumstances. Although Luhmann, Lucas, Eid, and Diener (2013) found evidence for adaptation to some conditions but much less to others, we still understand little of when or why these patterns occur. For example, the processes underlying scarring—when an event continues to affect SWB even after the unfortunate event is remedied—are barely understood. Notably, many of the factors that influence SWB in the long term have a negative effect, including unemployment and severe disability (Diener, Lucas, & Scollon, 2006). This has sparked research to determine the factors that increase SWB that are similarly robust to adaptation (Lyubomirsky, Sheldon, & Schkade, 2005). Thus, fully understanding adaptation to conditions remains a large area of open scholarship. Evidence from large cross-national studies suggests that chronic, macroenvironments such as corruption, climate, and progressive taxation play a substantial role in predicting individuals’ SWB (Oishi, 2012; Tay, Herian, & Diener, 2014). But some research psychologists have also focused on the effect of immediate situational factors, such as weather and moods at the time of SWB judgments (Schwarz & Clore, 1983), the effect of a preceding question (Strack, Martin, & Schwarz, 1988), and an arbitrary life event (Schwarz, Strack, Kommer, & Wagner, 1987). To our knowledge, however, very few studies have simultaneously examined the effects of macro- and microenvironments on SWB outcomes. Exploring the relative importance of macro- versus microenvironments and their interactive effects, therefore, promises to be a fruitful area for future research. Culture and SWB In the past decade, we have learned a lot about the interplay between culture and SWB (see Oishi & Gilbert, 2016; Uchida & Oishi, 2016 for reviews). In particular, psychologists have focused on three main sets of questions: (a) Is SWB composed of the same or of different components across cultures, and if these differ, are there universals? (b) Do the causes of SWB differ across cultures, and if so, are there any universal causes? (c) Are there mean level differences between cultures, and if so, what produces these? Culture and Concepts of Well-Being In order for cross-cultural comparisons to be meaningful, it is important to establish the equivalence of SWB. Wierzbicka (2004) demonstrated that the threshold for being “happy” in English is much lower than other languages, such as French (heureux) and German (glücklick). English speakers can use happy to say, for instance, “I am happy here reading,” whereas French or German speakers would not use heureux or glücklick in such a trivial context. Wierzbicka argued that English speakers are more likely to report having felt happy than French or Germans in part because the English term happy can be used more widely than the French or German term. Although this critique is logical and well taken, large international surveys often find that English speakers (e.g., Americans, Australians) also report being more satisfied with their lives than French and German. The key here is that the life satisfaction item does not use the controversial term happy, suggesting that these differences are less likely to be explained by differences between languages (see Diener, 2000). Still, Wierzbicka’s critique raises an important methodological issue in cross-cultural research and has inspired recent studies on the concepts of happiness across cultures and times. For example, Oishi, Graham, Kesebir, and Galinha (2013) conducted a dictionary analysis in 30 nations and found that in many languages (e.g., Chinese, Japanese, Turkish, Russian, and Norwegian), the primary definition of happiness was “good luck and fortune,” whereas in SUBJECTIVE WELL-BEING American English this definition was denoted “archaic” in 1961. According to a content analysis of the State of the Union addresses by the same group of researchers, U.S. presidents used the terms happy and happiness when referring to favorable conditions until around 1920, but after that they stopped using happy and happiness as good luck and fortune. In the same research, a Google Ngram analysis also showed that the term happy nation was more frequently used in books from 1800 till around 1920 than the term happy person, but after that happy person was used far more frequently than happy nation. Likewise, American concepts of happiness are predominantly positive, whereas some people outside North America (e.g., Iranians, Indonesians, Japanese) worry that too much happiness can bring some negative consequences (Joshanloo et al., 2014; Uchida & Kitayama, 2009). Such cultural perspectives on happiness are consistent with understanding happiness to mean good luck and fortune, which, by the very definition of “luck,” suggests that a series of lucky (happy) events are likely to be followed by unlucky events. These findings demonstrate that the concept of happiness differs across cultures and historical periods. Culture and the Composition of SWB In addition to the concept of happiness, research sugges...
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