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Multicontextual Life cycle

July 1, 2025/in Psychology Questions /by Besttutor

In this assignment, you will explain the Multicontextual Life Cycle Framework as well as completing a self-genogram of your family system. Complete the “Multicontextual Life Cycle Framework” worksheet. This assignment assesses the following programmatic competency: 6.1: Analyze the forms and functions of families at different developmental stages.

In order to analyze a family system, it is important to understand the multisystem structure. This assignment will help you learn this concept.

First, create a self-genogram of your family system, looking at it through the multisystem lens. Complete your family’s genogram and discuss your family system in terms of the family life cycle.

The genogram can be handwritten and scanned, done as a PDF, or done using Word tools to ensure it can be uploaded to LoudCloud. You can also go to the following site or another similar genogram site of your choice to download the GenPro software.

http://www.genopro.com/

Use the different phases listed in Figure 1.5 of the textbook to look at both the emotional process of transition and the second order tasks (If you have a large family, pick six to eight key individuals including yourself to discuss). Relate this to what your family members are going through in their lives presently (you can include key moments of the past – someone passing away, going through cancer treatment, miscarriage, etc.):

  • All family members
  • Include ages (if known), marriages, divorces, deaths
  • Substance use identified
  • Mental illness identified
  • All relationship dynamics

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PTSD case Vignette

July 1, 2025/in Psychology Questions /by Besttutor

Case 1: Jack

Jack Krull is a 26-year-old white male presenting with a shy demeanor. He made only fleeting eye contact and did not smile as he told the therapist in his first session that he knew he was overdue for getting help, mentioning that one of his problems is procrastination. He identifies that he has a lot of anxiety, which has worsened lately.

Jack has a degree in engineering and has held a job as a government patent examiner for the past 3 years since finishing college. He said that he gets very little work done, frustrated by the fact that each patent is different in scope and to find out how to approach it, he has to get information from others. Jack described how difficult it is to call people to do this. He does not know what to say and is afraid of stumbling over his words and sounding “stupid.” He also thought he would be judged for not knowing more.

Jack said he could not concentrate at work, spending most of his time procrastinating. He has received a warning from his supervisor for not meeting his quota. His job is solitary, and he does not interact with others at work, although everyone else there are “nerds” like him. However, some of them go to lunch with each other. He wonders whether it would be nice to join them rather than eating alone at his desk, but he does not feel he can do this since he is always so behind.

Jack is the product of a dating relationship between his mother and father, who had just come out of a divorce. His father indicated that Jack was a “mistake,” and Jack has had very little contact with him throughout the years and no monetary support. From his mother’s previous marriage, Jack has a half-sister, who is 3 years older. From his father, he has a half-brother from the previous marriage, and another half-brother from a subsequent marriage.

Jack said that his mother remarried when he was about 7 to a critical stepfather to whom he did not feel close. His stepfather was physically abusive to Jack’s mother. During these sporadic abusive episodes, Jack would remain in his room, feeling guilty for being unable to help. His mother left this man when Jack was 12.

Jack described his mother as overprotective growing up, exhorting him to do well in school and disallowing his attending social events because she did not want him getting into trouble. They lived in an isolated, rural setting.

Currently, Jack speaks to his mother about once a month on the phone, and he says they are not close. He tends to avoid her as much as possible and dreads talking to her. He says that he does not feel connected to any of his half siblings either.

Jack was diagnosed with ADHD as a child but could not describe any behaviors that warranted the diagnosis. He took stimulants for years but could not tell whether they helped or not. He is currently not on any medication. He says that he does not remember much about his childhood, but that, in general, he has a terrible memory. He has one memory of speaking in front of the class for a presentation when he was about 11 and starting to cry because he became so anxious.

 

Jack is currently living with his ex-girlfriend. They broke up after dating for 4 years, primarily because he was not interested in her sexually. She has been diagnosed with bipolar disorder, but from what he reports, she is stable on her medication and high functioning. (She is in a graduate studies program.)

Their lease will soon be up and Jack agonizes whether to get an apartment on his own or move with her to another place. On one hand, he feels very dependent on her but he also would not mind exploring what it would be like to be on his own. He has been with her since his senior year of college. However, he has a long-time fear of cockroaches and is afraid of choosing a place that has cockroaches.

Jack says he has some friends in the area to socialize with, but he does not feel close to them. He says he starts stammering, blushing, and shaking if he talks to more than one of his friends at a time. He does not know what to say or where to put his hands, and he focuses heavily on how he walks, believing he is doing it “wrong.” He also worries about what he will say and how he will handle interactions with clerks and shopkeepers. He goes to social events at times but usually “talks himself out” of going or leaves after a short time. He does not try to approach any women because he is afraid they would think he is being “obnoxious” and “hitting on them.” His self-talk is negative in that he calls himself “stupid” and that no one would like him. He is suspicious of people, thinking they are “fake” and “trying to get something.” Although Jack does not feel close to anyone except his ex-girlfriend, he says he feels more comfortable around women. He admits to feeling afraid of men, that they will yell at him or try to physically threaten him.

Jack says his appetite is fine, and he usually has three meals a day, but he does not eat as healthily as he should. He has a hard time sleeping at night and then has a difficult time waking up in the morning. He reports sporadic feelings of suicidality although he does not have an active plan and has never attempted suicide. He finds work so stressful that he is glad to retreat to his apartment in the evening. Still, he does not enjoy what he is doing there and constantly beats himself up about why he is not more productive at work so he can be rewarded with a more flexible schedule.

Case 2: Monica

Monica Moreno is a 20-year-old woman who was born in the U. S. Her parents at the time were recent immigrants, her mother Claudia from El Salvador and her father Enrique from Mexico. Monica said she heard her father had raped her mother (the families knew each other) and that Estelle had become pregnant as a result. They then married and bore two other children, Monica’s sister who is now 18 and a brother who is 12. Monica’s parents both worked long hours in food service when she was growing up. Her father worked his way up to a chef at this point in life, but Claudia is still stuck in minimum-wage positions.

Monica said that her mother was physically abusive, hitting Monica, sometimes with objects such as brooms, and berating her on a frequent basis as a child and teenager. Monica claimed to have been treated more harshly than her brother and sister. When Monica was about 7, she was sexually abused by her babysitter’s uncle. She said she remembers her mother examining her vagina with a flashlight to see if there was “damage” (it was a one-time incident of digital penetration). Monica said that she remembers leading her younger female cousins in watching pornography and touching each other when she was about 11. Her mother scolded her for being a “lez” for this incident. Monica said she was also sexually abused by a male cousin who was 2 years older from about 12–14 years. None of these incidents were reported, and she said no one in her family was aware of the last one.

She said that her father reportedly had sexually abused Monica’s mother’s younger sister but she said her father had always been appropriate with her and her sister, describing herself as a “Daddy’s girl.” She said that she now realizes her father is “manipulative” and a “pathological liar” and got Monica to side against her mother in the long period of their separation and divorce, (which was final when Monica was about 15). Her father was jealous and violent with her mother during this period of time. He, however, was a chronic “cheater” during the marriage. Monica said there were a few incidents that she and her siblings witnessed, the most memorable of which was when he threatened Estelle with a gun.

Monica discovered later that her mother was involved with a family friend from Mexico, and once she was divorced, she married him. Currently, Monica, lives with her mother, brother, stepfather, and Estelle’s new baby in a two-bedroom apartment. Monica said that she is sad that her brother, whom she cares for very much, is being neglected in favor of the new baby. She said he is withdrawn and gets poor grades, and she is worried for him. Her sister currently lives with her father about 2 hours away, and she has been in and out of residential treatment programs for the last year because of being suicidal. Monica said to her knowledge her sister had not been sexually abused.

When Monica was 14, she became involved with her boyfriend who is 4 years older. She said she loves him but is racked by insecurity. She said when she was 14, she flirted and kissed a couple of boys who were interested in her and still replays those incidents in her mind, castigating herself, and worrying that she has not confessed these incidents sufficiently to her boyfriend. She also constantly scrutinizes her behavior when she is not with her boyfriend, worried that she is not going to be able to control her flirting and perhaps even do something physically with them, especially when she has been drinking. She is also worried that her boyfriend will cheat on her and gets on his social media accounts, looking for clues. She said she constantly feels insecure and that her anxiety is almost unbearable, her thoughts racing in a near-constant loop on this subject. She denied any physical abuse by him but says that he has a problem with alcohol. He currently is unable to drive due to a DWI.

Monica said that she did poorly in school but well enough to get passed along. Although English is not her first language, she is well able to express herself, indeed, speaking rapidly and almost without stopping for the first session. She has taken classes this past year at the local community college and fails all her classes each semester. She is not sure what she would like to do but considers being a nurse’s aide. She admits to frequently not attending classes, forgetting about assignments, and being unable to concentrate when studying.

Monica holds a part-time job at a doctor’s office that her cousin, the office manager, got for her. She said she has a hard time remembering her duties at the job, and one of her coworkers is frequently irritated with her for not learning quickly enough and not working fast enough to keep up with the practice.

Monica said that she feels depressed sometimes when she wakes up but she mainly struggles with anxiety. She denies flashbacks and nightmares but has problems falling asleep and then cannot wake up in the morning for classes and work. She says she is late for work almost every day. She denies any problems with drugs and alcohol though says that she has about five drinks when she goes out with her friends and/or boyfriends to bars and parties on mostly weekend nights. She said that she is close to her sister, her female cousins, and a couple of girlfriends she has known since middle-school.

Appendix C: Directions and Template for “Reflect and Reply” Cases

 

Case

Directions Part I, Diagnosis

Given the case information, prepare the following: a diagnosis, the rationale for the diagnosis, and additional information you would have wanted to know in order to make a more accurate diagnosis.

Directions Part II, Biopsychosocial Risk and Resilience Assessment

 

Formulate a risk and resilience assessment, both for the onset of the disorder and for the course of the disorder, including the strengths that you see for this individual. What techniques could you use to elicit additional strengths in the client?

Biopsychosocial Risk and Resilience Assessment for Onset of the Disorder

 

Risk Influences

 

 

Resilience Influences

 

Biological

 

 

Psychological

 

 

Social

 

Biopsychosocial Risk and Resilience Assessment for Course of the Disorder

 

Risk Influences

 

 

Resilience Influences

 

Biological

 

 

Psychological

Social

Directions Part III, Goal Setting and Treatment Planning

Given your risk and resilience assessment of the individual, your knowledge of the disorder, and evidence-based practice guidelines, formulate goals and a possible treatment plan for this individual.

Directions Part IV, Critical Perspective

Formulate a critique of the diagnosis as it relates to this case example. Questions to consider include the following: Does this diagnosis represent a valid mental disorder from the social work perspective? Is this diagnosis significantly different from other possible diagnoses? Your critique should be based on the values of the social work profession (which are incongruent in some ways with the medical model) and the validity of the specific diagnostic criteria applied to this case.

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Graduate Level Psychology Help

July 1, 2025/in Psychology Questions /by Besttutor

Ethics in Psychology Course

 

Directions: This is three-part assignment, with different due dates. Please pay attention to each individual instruction and due date.

 

Part I Discussion Questions Due Date: Responses to questions #1, #2, #3 are due on 6/15/19 and #4, #5, #5, #7, #8 are due on 6/17/19 .

Directions: Respond to the questions in 100 words. You must cite your references and must provide original work. Please remember this is a psychology ethics class, therefore; the responses must reflect the class.

1. Why is the selection of culturally neutral assessment tools so critical to the ethical practice of psychology?

2. What potential harm can result if assessment materials are culture-bound?

3. What potential limitations do you foresee encountering with culturally neutral assessment tools?

4. According to the APA Ethics Code, what conditions would justify termination of therapy?

5. Do you agree with the prohibitions of termination of therapy? Why or why not?

6. List another reason why you agree or disagree with the prohibitions?

7. Provide citation and reference to the material(s) you discuss. Describe what you found interesting regarding this topic, and why.

8. Describe what may be unclear to you, and what you would like to learn.

 

Part II Individual Assignment ** Due Date: This part of the assignment is due 6/17/2019**

Directions: Please complete the attached worksheet. You must use cite references used in-text. Must be original work and cite all work! The scenario is found below!

***Scenario: Case 7. Handling Disparate Information for Evaluating Trainees

Rashid Vaji, PhD, a member of the school psychology faculty at a midsize university, serves as a faculty supervisor for students assigned to externships in schools. The department has formalized a supervision and evaluation system for the extern program. Students have weekly individual meetings with the faculty supervisor and biweekly meetings with the on-site supervisor. The on-site supervisor writes a midyear (December) and end of academic year (May) evaluation of each student. The site evaluations are sent to Dr. Vaji, and he provides

feedback based on the site and his own supervisory evaluation to each student. The final grade (fail, low pass, pass, high pass) is the responsibility of Dr. Vaji.

Dr. Vaji also teaches the spring semester graduate class Health Disparities in Mental Health. One of the course requirements is for students to write weekly thought papers, in which they take the perspective of therapy clients from different ethnic groups in reaction to specific session topics. Leo Watson, a second-year graduate student, is one of Dr. Vaji’s externship supervisees. He is also enrolled in the Health Disparities course. Leo’s thought papers often present ethnic-minority adolescents as prone to violence and unable to grasp the insights offered by school psychologists. In a classroom role-playing exercise, Leo plays an ethnic-minority student client as slumping in his chair, not understanding the psychologist, and giving angry retorts. In written comments on these thought papers and class feedback, Dr. Vaji encourages Leo to incorporate more of the readings on racial/ethnic discrimination and multicultural competence into his papers and to provide more complex perspectives on clients.

One day during his office hours, three students from the class come to Dr. Vaji’s office to complain about Leo’s behavior outside the classroom. They describe incidents in which Leo uses derogatory ethnic labels to describe his externship clients and brags about “putting one over” on his site supervisors by describing these clients in “glowing” terms just to satisfy his supervisors’ “stupid do-good” attitudes. They also report an incident at a local bar at which Leo was seen harassing an African American waitress, including by using racial slurs.

After the students have left his office, Dr. Vaji reviews his midyear evaluation and supervision notes on Leo and the midyear on-site supervisor’s report. In his own evaluation report, Dr. Vaji had written, “Leo often articulates a strong sense of duty to help his ethnic minority students overcome past discrimination but needs additional growth and supervision in applying a multicultural perspective to his clinical work.” The on-site supervisor’s evaluation states that

Leo has a wonderful attitude toward his student clients. . . . Unfortunately, evaluation of his multicultural treatment skills is limited because Leo has had fewer cases to discuss than some of his peers, since a larger than usual number of ethnic minority clients have stopped coming to their sessions with him.

It is the middle of the spring semester, and Dr. Vaji still has approximately 6 weeks of supervision left with Leo. The students’ complaints about Leo are consistent with what Dr. Vaji has observed in Leo’s class papers and role-playing exercises. However, these complaints are very different from Leo’s presentation during on-site supervision. If Leo has been intentionally deceiving both supervisors, then he may be more ineffective or harmful as a therapist to his current clients than either supervisor has realized. In addition, purposeful attempts to deceive the supervisors might indicate a personality disorder or lack of integrity that, if left unaddressed, might be harmful to adolescent clients in the future.

 

Ethical Dilemma

Dr. Vaji would like to meet with Leo to discuss, at a minimum, ways to retain adolescent clients and to improve his multicultural treatment skills. He does not know to what extent his conversation with Leo and final supervisory report should be influenced by the information provided by the other graduate students.*******

 

Part III Group Assignment ** Due Date 06/16/2019 before 10:00 am EST**

This is a group assignment, however; I am responsible for only 1 slide . The slide must include detailed speaker notes and must also include information on the slide. Attached you will find a copy the group’s PowerPoint. Please add to the PowerPoint and add the peer-reviewed references to the project.

 

Directions: Develop 1-Microsoft® PowerPoint® presentation with detailed speaker notes on the selection process of a culture-neutral assessment .

My Slide: Examples of when culture biased assessments have been problematic

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Share Your Thoughts Chapter 15

July 1, 2025/in Psychology Questions /by Besttutor

Midlife is a time of increased generativity—giving to and guiding younger generations. Charles Callis, director of New Zealand’s Olympic Museum, shows visiting schoolchildren how to throw a discus. His enthusiastic demonstration conveys the deep sense of satisfaction he derives from generative activities.

chapter outline

·   Erikson’s Theory: Generativity versus Stagnation

· ■  SOCIAL ISSUES: HEALTH  Generative Adults Tell Their Life Stories

Other Theories of Psychosocial Development in Midlife

·   Levinson’s Seasons of Life

·   Vaillant’s Adaptation to Life

·   Is There a Midlife Crisis?

·   Stage or Life Events Approach

Stability and Change in Self-Concept and Personality

·   Possible Selves

·   Self-Acceptance, Autonomy, and Environmental Mastery

·   Coping with Daily Stressors

·   Gender Identity

·   Individual Differences in Personality Traits

· ■  BIOLOGY AND ENVIRONMENT  What Factors Promote Psychological Well-Being in Midlife?

Relationships at Midlife

·   Marriage and Divorce

·   Changing Parent–Child Relationships

·   Grandparenthood

·   Middle-Aged Children and Their Aging Parents

·   Siblings

·   Friendships

· ■  SOCIAL ISSUES: HEALTH  Grandparents Rearing Grandchildren: The Skipped-Generation Family

·   Vocational Life

·   Job Satisfaction

·   Career Development

·   Career Change at Midlife

·   Unemployment

·   Planning for Retirement

image2

One weekend when Devin, Trisha, and their 24-year-old son, Mark, were vacationing together, the two middle-aged parents knocked on Mark’s hotel room door. “Your dad and I are going off to see a crafts exhibit,” Trisha explained. “Feel free to stay behind,” she offered, recalling Mark’s antipathy toward attending such events as an adolescent. “We’ll be back around noon for lunch.”

“That exhibit sounds great!” Mark replied. “I’ll meet you in the lobby.”

“Sometimes I forget he’s an adult!” exclaimed Trisha as she and Devin returned to their room to grab their coats. “It’s been great to have Mark with us—like spending time with a good friend.”

In their forties and fifties, Trisha and Devin built on earlier strengths and intensified their commitment to leaving a legacy for those who would come after them. When Mark faced a difficult job market after graduating from college, he returned home to live with Trisha and Devin and remained there for several years. With their support, he took graduate courses while working part-time, found steady employment in his late twenties, fell in love, and married in his mid-thirties. With each milestone, Trisha and Devin felt a sense of pride at having escorted a member of the next generation into responsible adult roles. Family activities, which had declined during Mark’s adolescent and college years, increased as Trisha and Devin related to their son as an enjoyable adult companion. Challenging careers and more time for community involvement, leisure pursuits, and each other contributed to a richly diverse and gratifying time of life.

image3

The midlife years were not as smooth for two of Trisha and Devin’s friends. Fearing that she might grow old alone, Jewel frantically pursued her quest for an intimate partner. She attended singles events, registered with dating services, and traveled in hopes of meeting a like-minded companion. “I can’t stand the thought of turning 50,” she lamented in a letter to Trisha. Jewel also had compensating satisfactions—friendships that had grown more meaningful, a warm relationship with a nephew and niece, and a successful consulting business.

Tim, Devin’s best friend from graduate school, had been divorced for over five years. Recently, he had met Elena and had come to love her deeply. But Elena was in the midst of major life changes. In addition to her own divorce, she was dealing with a troubled daughter, a career change, and a move away from the city that served as a constant reminder of her unhappy past. Whereas Tim had reached the peak of his career and was ready to enjoy life, Elena wanted to recapture much of what she had missed in earlier decades, including opportunities to realize her talents. “I don’t know where I fit into Elena’s plans,” Tim wondered aloud on the phone with Trisha.

With the arrival of middle adulthood, half or more of the lifespan is over. Increasing awareness of limited time ahead prompts adults to reevaluate the meaning of their lives, refine and strengthen their identities, and reach out to future generations. Most middle-aged people make modest adjustments in their outlook, goals, and daily lives. But a few experience profound inner turbulence and initiate major changes, often in an effort to make up for lost time. Together with advancing years, family and work transitions contribute greatly to emotional and social development.

More midlifers are addressing these tasks than ever before, now that the baby boomers have reached their forties, fifties, and sixties (see  page 12  in  Chapter 1  to review how baby boomers have reshaped the life course). Indeed, 45- to 54-year-olds are currently the largest age sector of the U.S. population, and they are healthier, better educated, and—despite the late-2000s recession—more financially secure than any previous midlife cohort (U.S. Census Bureau,  2012b ; Whitbourne & Willis,  2006 ). As our discussion will reveal, they have brought increased self-confidence, social consciousness, and vitality—along with great developmental diversity—to this period of the lifespan.

A monumental survey called Midlife Development in the United States (MIDUS), conducted in the mid-1990s, has contributed enormously to our understanding of midlife emotional and social development. Conceived by a team of researchers spanning diverse fields, including psychology, sociology, anthropology, and medicine, the aim of MIDUS was to generate new knowledge on the challenges faced by middle-aged adults. Its nationally representative sample included over 7,000 U.S. 25- to 75-year-olds, enabling those in the middle years to be compared with younger and older individuals. Through telephone interviews and self-administered questionnaires, participants responded to over 1,100 items addressing wide-ranging psychological, health, and background factors, yielding unprecedented breadth of information in a single study (Brim, Ryff, & Kessler,  2005 ). The research endeavor also included “satellite” studies, in which subsamples of respondents were questioned in greater depth on key topics. And it has been extended longitudinally, with 75 percent of the sample recontacted at first follow-up, in the mid-2000s (Radler & Ryff,  2010 ).

MIDUS has greatly expanded our knowledge of the multidimensional and multidirectional nature of midlife change, and it promises to be a rich source of information about middle adulthood and beyond for many years to come. Hence, our discussion repeatedly draws on MIDUS, at times delving into its findings, at other times citing them alongside those of other investigations. Let’s turn now to Erikson’s theory and related research, to which MIDUS has contributed.

image4 Erikson’s Theory: Generativity versus Stagnation

image5

Through his work with severely malnourished children in Niger, this nurse, affiliated with the Nobel Prize–winning organization Doctors Without Borders, integrates personal goals with a broader concern for society.

Erikson’s psychological conflict of midlife is called  generativity versus stagnation.  Generativity involves reaching out to others in ways that give to and guide the next generation. Recall from  Chapter 14  that generativity is under way in early adulthood through work, community service, and childbearing and child rearing. Generativity expands greatly in midlife, when adults focus more intently on extending commitments beyond oneself (identity) and one’s life partner (intimacy) to a larger group—family, community, or society. The generative adult combines the need for self-expression with the need for communion, integrating personal goals with the welfare of the larger social world (McAdams & Logan,  2004 ). The resulting strength is the capacity to care for others in a broader way than previously.

Erikson ( 1950 ) selected the term generativity to encompass everything generated that can outlive the self and ensure society’s continuity and improvement: children, ideas, products, works of art. Although parenting is a major means of realizing generativity, it is not the only means: Adults can be generative in other family relationships (as Jewel was with her nephew and niece), as mentors in the workplace, in volunteer endeavors, and through many forms of productivity and creativity.

Notice, from what we have said so far, that generativity brings together personal desires and cultural demands. On the personal side, middle-aged adults feel a need to be needed—to attain symbolic immortality by making a contribution that will survive their death (Kotre,  1999 ; McAdams, Hart, & Maruna,  1998 ). This desire may stem from a deep-seated evolutionary urge to protect and advance the next generation. On the cultural side, society imposes a social clock for generativity in midlife, requiring adults to take responsibility for the next generation through their roles as parents, teachers, mentors, leaders, and coordinators (McAdams & Logan,  2004 ). And according to Erikson, a culture’s “belief in the species”—the conviction that life is good and worthwhile, even in the face of human destructiveness and deprivation—is a major motivator of generative action. Without this optimistic worldview, people would have no hope of improving humanity.

The negative outcome of this stage is stagnation: Once people attain certain life goals, such as marriage, children, and career success, they may become self-centered and self-indulgent. Adults with a sense of stagnation express their self-absorption in many ways—through lack of interest in young people (including their own children), through a focus on what they can get from others rather than what they can give, and through taking little interest in being productive at work, developing their talents, or bettering the world in other ways.

Some researchers study generativity by asking people to rate themselves on generative characteristics, such as feelings of duty to help others in need or obligation to be an involved citizen. Others ask open-ended questions about life goals, major high points, and most satisfying activities, rating people’s responses for generative references. And still others look for generative themes in people’s narrative descriptions of themselves (Keyes & Ryff,  1998a ,  1998b ; McAdams,  2006 ,  2011 ; Newton & Stewart,  2010 ; Rossi,  2001 ,  2004 ). Whichever method is used, generativity tends to increase in midlife. For example, in longitudinal and cross-sectional studies of college-educated women, and in an investigation of middle-aged adults diverse in SES, self-rated generativity rose throughout middle adulthood (see  Figure 16.1 ). At the same time, participants expressed greater concern about aging, increased security with their identities, and a stronger sense of competence (Miner-Rubino, Winter, & Stewart,  2004 ; Stewart, Ostrove, & Helson,  2001 ; Zucker, Ostrove, & Stewart,  2002 ). As the Social Issues: Health box on  page 534  illustrates, generativity is also a major unifying theme in middle-aged adults’ life stories.

image6

FIGURE 16.1 Age-related changes in self-rated generativity, concern about aging, identity security, and sense of competence.

In a longitudinal study of over 300 college-educated women, self-rated generativity increased from the thirties to the fifties, as did concern about aging. The rise in generativity was accompanied by other indicators of psychological health—greater security with one’s identity and sense of competence.

(Adapted from Stewart, Ostrove, & Helson, 2001.)

Just as Erikson’s theory suggests, highly generative people appear especially well-adjusted—low in anxiety and depression; high in autonomy, self-acceptance, and life satisfaction; and more likely to have successful marriages and close friends (Ackerman, Zuroff, & Moskowitz,  2000 ; An & Cooney,  2006 ; Grossbaum & Bates,  2002 ; Westermeyer,  2004 ). They are also more open to differing viewpoints, possess leadership qualities, desire more from work than financial rewards, and care greatly about the welfare of their children, their partner, their aging parents, and the wider society (Peterson,  2002 ; Peterson, Smirles, & Wentworth,  1997 ). Furthermore, generativity is associated with more effective child rearing—higher valuing of trust, open communication, transmission of generative values to children, and an authoritative style (Peterson,  2006 ; Peterson & Duncan,  2007 ; Pratt et al.,  2008 ). Generative midlifers are also more involved in political activities, including voting, campaigning, and contacting public officials (Cole & Stewart,  1996 ).

Although these findings characterize adults of all backgrounds, individual differences in contexts for generativity exist. Having children seems to foster generative development in both men and women. In several studies, including the MIDUS survey, fathers scored higher in generativity than childless men (Marks, Bumpass, & Jun,  2004 ; McAdams & de St. Aubin,  1992 ; Snarey et al.,  1987 ). Similarly, in an investigation of well-educated women from ages 43 to 63, those with family commitments (with or without a career) expressed greater generative concerns than childless women who were solely focused on their careers (Newton & Stewart,  2010 ). Parenting seems to spur especially tender, caring attitudes toward succeeding generations.

For low-SES men with troubled pasts as sons, students, workers, and intimate partners, fatherhood can provide a context for highly generative, positive life change (Roy & Lucas,  2006 ). At times, these fathers express this generativity as a refusal to pass on their own history of suffering. As one former gang member, who earned an associate’s degree and struggled to keep his teenage sons off the streets, explained, “I came through the depths of hell to try to be a father. I let my sons know, ‘You’re never without a daddy, don’t you let anybody tell you that.’ I tell them that if me and your mother separate, I make sure that wherever I go, I build something for you to come to” ( p. 153 ).

Social Issues: Health Generative Adults Tell Their Life Stories

In research aimed at understanding how highly generative adults make sense of their lives, Dan McAdams and his colleagues interviewed two groups of midlifers: those who often behave generatively and those who seldom do. Participants were asked to relate their life stories, including a high point, a low point, a turning point, and important scenes from childhood, adolescence, and adulthood (McAdams,  2006 ,  2011 ; McAdams et al.,  2001 ). Analyses of story lines and themes revealed that adults high and low in generativity reconstruct their past and anticipate their future in strikingly different ways.

Narratives of highly generative people usually contained an orderly sequence of events that the researchers called a commitment story, in which adults give to others as a means of giving back to family, community, and society (McAdams,  2006 ). The generative storyteller typically describes an early special advantage (such as a good family or a talent), along with early awareness of the suffering of others. This clash between blessing and suffering motivates the person to view the self as “called,” or committed, to being good to others. In commitment stories, the theme of redemption is prominent. Highly generative adults frequently describe scenes in which extremely negative life events, involving frustration, failure, loss, or death, are redeemed, or made better, by good outcomes—personal renewal, improvement, and enlightenment.

Consider a story related by Diana, a 49-year-old fourth-grade teacher. Born in a small town to a minister and his wife, Diana was a favorite among the parishioners, who showered her with attention and love. When she was 8, however, her life hit its lowest point: As she looked on in horror, her younger brother ran into the street and was hit by a car; he died later that day. Afterward, Diana, sensing her father’s anguish, tried—unsuccessfully—to be the “son” he had lost. But the scene ends on an upbeat note, with Diana marrying a man who forged a warm bond with her father and who became accepted “as his own son.” One of Diana’s life goals was to improve her teaching, because “I’d like to give something back … to grow and help others grow” (McAdams et al.,  1997 , p. 689). Her interview overflowed with expressions of generative commitment.

Whereas highly generative adults tell stories in which bad scenes turn good, less generative adults relate stories with themes of contamination, in which good scenes turn bad. For example, a good first year of college turns sour when a professor grades unfairly. A young woman loses weight and looks good but can’t overcome her low self-esteem.

Why is generativity connected to life-story redemption events? First, some adults may view their generative activities as a way to redeem negative aspects of their lives. In a study of the life stories of ex-convicts who turned away from crime, many spoke of a strong desire to do good works as penance for their transgressions (Maruna,  2001 ; Maruna, LeBel, & Lanier,  2004 ). Second, generativity seems to entail the conviction that the imperfections of today can be transformed into a better tomorrow. Through guiding and giving to the next generation, mature adults increase the chances that the mistakes of the past will not happen again. Finally, interpreting one’s own life in terms of redemption offers hope that hard work will lead to future benefits—an expectation that may sustain generative efforts of all kinds, from rearing children to advancing communities and societies.

Life stories offer insight into how people imbue their lives with meaning and purpose. Adults high and low in generativity do not differ in the number of positive and negative events included in their narratives. Rather, they interpret those events differently. Commitment stories, filled with redemption, involve a way of thinking about the self that fosters a caring, compassionate approach to others (McAdams & Logan,  2004 ). Such stories help people realize that although their own personal story will someday end, other stories will follow, due in part to their own generative efforts.

The more redemptive events adults include in their life stories, the higher their self-esteem, life satisfaction, and certainty that the challenges of life are meaningful, manageable, and rewarding (Lilgendahl & McAdams,  2011 ; McAdams,  2001 ). Researchers still have much to learn about factors that lead people to view good as emerging from adversity.

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Carlos Arredondo, who lost his older son in the Iraq War and his younger son to suicide, now travels the country, telling the story of how he overcame despair and committed himself to campaigning for peace in his sons’ memory. After the Boston Marathon bombings in April 2013, Arredondo, a spectator, leapt into action and rescued this gravely injured bystander.

Finally, compared with Caucasians, African Americans more often engage in certain types of generativity. They are more involved in religious groups and activities, offer more social support to members of their community, and are more likely to view themselves as role models and sources of wisdom for their children (Hart et al.,  2001 ). A life history of strong support from church and extended family may strengthen these generative values and actions. Among Caucasian Americans, religiosity and spirituality are also linked to greater generative activity (Dillon & Wink,  2004 ; Son & Wilson,  2011 ; Wink & Dillon,  2008 ). Highly generative middle-aged adults often indicate that as children and adolescents, they internalized moral values rooted in a religious tradition and sustained their commitment to those values, which provided lifelong encouragement for generative action (McAdams,  2006 ). Especially in individualistic societies, belonging to a religious community or believing in a higher being may help preserve generative commitments.

image8 Other Theories of Psychosocial Development in Midlife

Erikson’s broad sketch of psychosocial change in midlife has been extended by Levinson and Vaillant. Let’s revisit their theories, which were introduced in  Chapter 14 .

Levinson’s Seasons of Life

Return to  page 470  to review Levinson’s eras (seasons of life). His interviews with adults revealed that middle adulthood begins with a transition, during which people evaluate their success in meeting early adulthood goals. Realizing that from now on, more time will lie behind than ahead, they regard the remaining years as increasingly precious. Consequently, some make drastic revisions in their life structure: divorcing, remarrying, changing careers, or displaying enhanced creativity. Others make smaller changes in the context of marital and occupational stability.

· Whether these years bring a gust of wind or a storm, most people turn inward for a time, focusing on personally meaningful living (Neugarten,  1968b ). According to Levinson, to reassess and rebuild their life structure, middle-aged adults must confront four developmental tasks. Each requires the individual to reconcile two opposing tendencies within the self, attaining greater internal harmony.

· ● Young–old: The middle-age person must seek new ways of being both young and old. This means giving up certain youthful qualities, transforming others, and finding positive meaning in being older. Perhaps because of the double standard of aging (see  pages 516 – 517  in  Chapter 15 ), most middle-aged women express concern about appearing less attractive as they grow older (Rossi,  2005 ). But middle-aged men—particularly non-college-educated men, who often hold blue-collar jobs requiring physical strength and stamina—are also highly sensitive to physical aging. In one study, they were more concerned about physical changes than both college- and non-college-educated women, who exceeded college-educated men (Miner-Rubino, Winter, & Stewart,  2004 ).

Compared with previous midlife cohorts, U.S. baby boomers are especially interested in controlling physical changes—a desire that has helped energize a huge industry of anti-aging cosmetic products and medical procedures (Jones, Whitbourne, & Skultety,  2006 ; Lachman,  2004 ). And sustaining a youthful subjective age (feeling younger than one’s actual age) is more strongly related to self-esteem and psychological well-being among American than Western-European middle-aged and older adults (Westerhof & Barrett,  2005 ; Westerhof, Whitbourne, & Freeman,  2012 ). In the more individualistic U.S. context, a youthful self-image seems more important for viewing oneself as self-reliant and capable of planning for an active, fulfilling late adulthood.

· ● Destruction–creation: With greater awareness of mortality, the middle-aged person focuses on ways he or she has acted destructively. Past hurtful acts toward parents, intimate partners, children, friends, and co-workers are countered by a strong desire to participate in activities that advance human welfare and leave a legacy for future generations. The image of a legacy can be satisfied in many ways—through charitable gifts, creative products, volunteer service, or mentoring young people.

· ● Masculinity–femininity: The middle-aged person must create a better balance between masculine and feminine parts of the self. For men, this means greater acceptance of “feminine” traits of nurturance and caring, which enhance close relationships and compassionate exercise of authority in the workplace. For women, it generally means being more open to “masculine” characteristics of autonomy and assertiveness. Recall from  Chapter 8  that people who combine masculine and feminine traits have an androgynous gender identity. Later we will see that androgyny is associated with favorable personality traits and adjustment.

· ● Engagement–separateness: The middle-aged person must forge a better balance between engagement with the external world and separateness. For many men, and for women who have had successful careers, this may mean reducing concern with ambition and achievement and attending more fully to oneself. But women who have been devoted to child rearing or an unfulfilling job often feel compelled to move in the other direction (Levinson,  1996 ). At age 48, Elena left her position as a reporter for a small-town newspaper, pursued an advanced degree in creative writing, accepted a college teaching position, and began writing a novel. Tim, in contrast, recognized his overwhelming desire for a gratifying romantic partnership. By scaling back his own career, he realized he could grant Elena the time and space she needed to build a rewarding work life—and that doing so might deepen their attachment to each other.

People who flexibly modify their identities in response to age-related changes yet maintain a sense of self-continuity are more aware of their own thoughts and feelings and are higher in self-esteem and life satisfaction (Jones, Whitbourne, & Skultety,  2006 ; Sneed et al.,  2012 ). But adjusting one’s life structure to incorporate the effects of aging requires supportive social contexts. When poverty, unemployment, and lack of a respected place in society dominate the life course, energies are directed toward survival rather than realistically approaching age-related changes. And even adults whose jobs are secure and who live in pleasant neighborhoods may find that employment conditions restrict possibilities for growth by placing too much emphasis on productivity and profit and too little on the meaning of work. In her early forties, Trisha left a large law firm, where she felt constant pressure to bring in high-fee clients and received little acknowledgment of her efforts, for a small practice.

Opportunities for advancement ease the transition to middle adulthood. Yet these are far less available to women than to men. Individuals of both sexes in blue-collar jobs also have few possibilities for promotion. Consequently, they make whatever vocational adjustments they can—becoming active union members, shop stewards, or mentors of younger workers (Christensen & Larsen,  2008 ; Levinson,  1978 ). Many men find compensating rewards in moving to the senior generation of their families.

Vaillant’s Adaptation to Life

Whereas Levinson interviewed 35- to 45-year-olds, Vaillant ( 1977 ,  2002 )—in his longitudinal research on well-educated men and women—followed participants past the half-century mark. Recall from  Chapter 14 how adults in their late fifties and sixties extend their generativity, becoming “keepers of meaning,” or guardians of their culture (see  page 471 ). Vaillant reported that the most-successful and best-adjusted entered a calmer, quieter time of life. “Passing the torch”—concern that the positive aspects of their culture survive—became a major preoccupation.

In societies around the world, older people are guardians of traditions, laws, and cultural values. This stabilizing force holds in check too-rapid change sparked by the questioning and challenging of adolescents and young adults. As people approach the end of middle age, they focus on longer-term, less-personal goals, such as the state of human relations in their society. And they become more philosophical, accepting the fact that not all problems can be solved in their lifetime.

Is There a Midlife Crisis?

Levinson ( 1978 ,  1996 ) reported that most men and women in his samples experienced substantial inner turmoil during the transition to middle adulthood. Yet Vaillant ( 1977 ,  2002 ) saw few examples of crisis but, rather, slow and steady change. These contrasting findings raise the question of how much personal upheaval actually accompanies entry to midlife. Are self-doubt and stress especially great during the forties, and do they prompt major restructuring of the personality, as the term  midlife crisis  implies?

Consider the reactions of Trisha, Devin, Jewel, Tim, and Elena to middle adulthood. Trisha and Devin moved easily into this period, whereas Jewel, Tim, and Elena engaged in greater questioning of their situations and sought alternative life paths. Clearly, wide individual differences exist in response to mid-life.  TAKE A MOMENT…  Now ask several individuals in their twenties and thirties whether they expect to encounter a midlife crisis between ages 40 and 50. You are likely to find that Americans often anticipate it, perhaps because of culturally induced apprehension of aging (Wethington, Kessler, & Pixley,  2004 ). Yet little evidence supports this view of middle age as a turbulent time.

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Like many midlifers, elementary school teacher Jaime Malwitz modified his career in ways that resemble a turning point, not a crisis. He designed a scientist-in-residence program for elementary schools. Here he serves as a resident physicist, discussing a density experiment with a fifth grader.

When MIDUS participants were asked to describe “turning points” (major changes in the way they felt about an important aspect of their lives) that had occurred during the past five years, most of the ones reported concerned work. Women’s work-related turning points peaked in early adulthood, when many adjusted their work lives to accommodate marriage and childrearing (see  Chapter 14 ). The peak for men, in contrast, came at midlife, a time of increased career responsibility and advancement. Other common turning points in early and middle adulthood were positive: They involved fulfilling a dream and learning something good about oneself (Wethington, Kessler, & Pixley,  2004 ). Overall, turning points rarely resembled midlife crises. Even negative work-related turning points generally led to personal growth—for example, a layoff that sparked a positive career change or a shift in energy from career to personal life.

Asked directly if they had ever experienced something they would consider a midlife crisis, only one-fourth of the MIDUS respondents said yes. And they defined such events much more loosely than researchers do. Some reported a crisis well before age 40, others well after age 50. And most attributed it not to age but rather to challenging life events (Wethington,  2000 ). Consistent with this view, Elena had considered both a divorce and a new career long before she initiated these changes. In her thirties, she separated from her husband; later she reconciled with him and told him that she desired to return to school, which he firmly opposed. She put her own life on hold because of her daughter’s academic and emotional difficulties and her husband’s resistance.

Another way of exploring midlife questioning is to ask adults about life regrets—attractive opportunities for career or other life-changing activities they did not pursue or lifestyle changes they did not make. In two investigations of women in their early forties, those who acknowledged regret without making life changes, compared to those who modified their lives, reported less favorable psychological well-being and poorer physical health over time (Landman et al.,  1995 ; Stewart & Vandewater,  1999 ). The two groups did not differ in social or financial resources available to effect change. Rather, they differed in personality: Those who made changes were higher in confidence and assertiveness.

By late midlife, with less time ahead to make life changes, people’s interpretation of regrets plays a major role in their well-being. Mature, contented adults acknowledge a past characterized by some losses, have thought deeply about them, and feel stronger because of them. At the same time, they are able to disengage from them, investing in current, personally rewarding goals (King & Hicks,  2007 ). Among a sample of several hundred 60- to 65-year-olds diverse in SES, about half expressed at least one regret. Compared to those who had not resolved their disappointments, those who had come to terms with them (accepted and identified some eventual benefits) or had “put the best face on things” (identified benefits but still had some lingering regret) reported better physical health and greater life satisfaction (Torges, Stewart, & Miner-Rubino,  2005 ).

In sum, life evaluation is common during middle age. Most people make changes that are best described as turning points rather than drastic alterations of their lives. Those who cannot modify their life paths often look for the “silver lining” in life’s difficulties (King & Hicks,  2007 ; Wethington, Kessler, & Pixley,  2004 ). The few midlifers who are in crisis typically have had early adulthoods in which gender roles, family pressures, or low income and poverty severely limited their ability to fulfill personal needs and goals, at home or in the wider world.

Stage or Life Events Approach

That crisis and major restructuring in midlife are rare raises, once again, a question we considered in  Chapter 14 : Can adult psychosocial changes can be organized into stages, as Erikson’s, Levinson’s, and Vaillant’s theories indicate? A growing number of researchers believe the midadult transition is not stagelike (Freund & Ritter,  2009 ; McCrae & Costa,  2003 ; Srivastava et al.,  2003 ). Some regard it as simply an adaptation to normative life events, such as children growing up, reaching the crest of a career, and impending retirement.

Yet recall from earlier chapters that life events are no longer as age-graded as they were in the past. Their timing is so variable that they cannot be the sole cause of midlife change. Furthermore, in several studies, people were asked to trace their thoughts, feelings, attitudes, and hopes during early and middle adulthood. Psychosocial change, in terms of personal disruption followed by reassessment, coincided with both family life cycle events and chronological age. For this reason, most experts regard adaptation during midlife as the combined result of growing older and social experiences (Lachman,  2004 ; Sneed, Whitbourne, & Culang,  2006 ).  TAKE A MOMENT…  Return to our discussion of generativity and the midlife transition on  page 533 , and notice how both factors are involved.

Finally, in describing their lives, the large majority of middle-aged people report troubling moments that prompt new understandings and goals. As we look closely at emotional and social development in middle adulthood, we will see that this period, like others, is characterized by both continuity and change. Debate persists over whether midlife psychosocial changes are stagelike. With this in mind, let’s turn to the diverse inner concerns and outer experiences that contribute to psychological well-being and decision making in midlife.

ASK YOURSELF

REVIEW What personal and cultural forces motivate generativity? Why does it increase and contribute vitally to favorable adjustment in midlife?

CONNECT How might the approach of many middle-aged adults to handling life regrets prevent the occurrence of midlife crises?

APPLY After years of experiencing little personal growth at work, 42-year-old Mel looked for a new job and received an attractive offer in another city. Although he felt torn between leaving close friends and pursuing a long-awaited career opportunity, after several weeks of soul searching, he took the new job. Was Mel’s dilemma a midlife crisis? Why or why not?

REFLECT Think of a middle-aged adult whom you admire. Describe the various ways that individual expresses generativity.

image10 Stability and Change in Self-Concept and Personality

Midlife changes in self-concept and personality reflect growing awareness of a finite lifespan, longer life experience, and generative concerns. Yet certain aspects of personality remain stable, revealing the persistence of individual differences established during earlier periods.

Possible Selves

On a business trip, Jewel found a spare afternoon to visit Trisha. Sitting in a coffee shop, the two women reminisced about the past and thought aloud about the future. “It’s been tough living on my own and building the business,” Jewel said. “What I hope for is to become better at my work, to be more community-oriented, and to stay healthy and available to my friends. Of course, I would rather not grow old alone, but if I don’t find that special person, I suppose I can take comfort in the fact that I’ll never have to face divorce or widowhood.”

Jewel is discussing  possible selves,  future-oriented representations of what one hopes to become and what one is afraid of becoming. Possible selves are the temporal dimension of self-concept—what the individual is striving for and attempting to avoid. To lifespan researchers, these hopes and fears are just as vital in explaining behavior as people’s views of their current characteristics. Indeed, possible selves may be an especially strong motivator of action in midlife, as adults attach increased meaning to time (Frazier & Hooker,  2006 ). As we age, we may rely less on social comparisons in judging our self-worth and more on temporal comparisons—how well we are doing in relation to what we had planned.

Throughout adulthood, the personality traits people assign to their current selves show considerable stability. A 30-year-old who says he is cooperative, competent, outgoing, or successful is likely to report a similar picture at a later age. But reports of possible selves change greatly. Adults in their early twenties mention many possible selves, and their visions are lofty and idealistic—being “perfectly happy,” “rich and famous,” “healthy throughout life,” and not being “down and out” or “a person who does nothing important.” With age, possible selves become fewer in number and more modest and concrete. Most middle-aged people no longer desire to be the best or the most successful. Instead, they are largely concerned with performance of roles and responsibilities already begun—“being competent at work,” “being a good husband and father,” “putting my children through the colleges of their choice,” “staying healthy,” and not being “a burden to my family” or “without enough money to meet my daily needs” (Bybee & Wells,  2003 ; Cross & Markus,  1991 ; Ryff,  1991 ).

What explains these shifts in possible selves? Because the future no longer holds limitless opportunities, adults preserve mental health by adjusting their hopes and fears. To stay motivated, they must maintain a sense of unachieved possibility, yet they must still manage to feel good about themselves and their lives despite disappointments (Lachman & Bertrand,  2002 ). For example, Jewel no longer desired to be an executive in a large company, as she had in her twenties. Instead, she wanted to grow in her current occupation. And although she feared loneliness in old age, she reminded herself that marriage can lead to equally negative outcomes, such as divorce and widowhood—possibilities that made not having attained an important interpersonal goal easier to bear.

Unlike current self-concept, which is constantly responsive to others’ feedback, possible selves (though influenced by others) can be defined and redefined by the individual, as needed. Consequently, they permit affirmation of the self, even when things are not going well (Bolkan & Hooker,  2012 ). Researchers believe that possible selves may be the key to continued well-being in adulthood, as people revise these future images to achieve a better match between desired and achieved goals. Many studies reveal that the self-esteem of middle-aged and older individuals equals or surpasses that of younger people, perhaps because of the protective role of possible selves (Robins & Trzesniewski,  2005 ).

Self-Acceptance, Autonomy, and Environmental Mastery

An evolving mix of competencies and experiences leads to changes in certain aspects of personality during middle adulthood. In  Chapter 15 , we noted that midlife brings gains in expertise and practical problem solving. Middle-aged adults also offer more complex, integrated descriptions of themselves than do younger and older individuals (Labouvie-Vief,  2003 ). Furthermore, midlife is typically a period in which the number of social roles peaks—spouse, parent, worker, and engaged community member. And status at work and in the community typically rises, as adults take advantage of opportunities for leadership and other complex responsibilities (Helson, Soto, & Cate,  2006 ).

· These changes in cognition and breadth of roles undoubtedly contribute to other gains in personal functioning. In research on adults ranging in age from the late teens into the seventies, and in cultures as distinct as the United States and Japan, three qualities increased from early to middle adulthood:

· ● Self-acceptance: More than young adults, middle-aged people acknowledged and accepted both their good and bad qualities and felt positively about themselves and life.

· ● Autonomy: Middle-aged adults saw themselves as less concerned about others’ expectations and evaluations and more concerned with following self-chosen standards.

· ● Environmental mastery: Middle-aged people saw themselves as capable of managing a complex array of tasks easily and effectively (Karasawa et al.,  2011 ; Ryff & Keyes,  1995 ).

As these findings indicate, midlife is generally a time of increased comfort with the self, independence, assertiveness, commitment to personal values, and life satisfaction (Helson, Jones, & Kwan,  2002 ; Keyes, Shmotkin, & Ryff,  2002 ; Stone et al.,  2010 ). Perhaps because of this rise in overall psychological well-being, middle age is sometimes referred to as “the prime of life.”

At the same time, factors contributing to psychological well-being differ substantially among cohorts, as self-reports gathered from 25- to 65-year-old MIDUS survey respondents reveal (Carr,  2004 ). Among women who were born during the baby-boom years or later, and who thus benefited from the women’s movement, balancing career with family predicted greater self-acceptance and environmental mastery. But also consider that women born before or during World War II who sacrificed career to focus on child rearing—expected of young mothers in the 1950s and 1960s—were similarly advantaged in self-acceptance. Likewise, men who were in step with prevailing social expectations scored higher in well-being. Baby-boom and younger men who modified their work schedules to make room for family responsibilities—who fit their cohort’s image of the “good father”—were more self-accepting. But older men who made this accommodation scored much lower in self-acceptance than those who focused on work and thus conformed to the “good provider” ideal of their times. (See the Biology and Environment box on  pages 540 – 541  for additional influences on midlife psychological well-being.)

Notions of happiness, however, vary among cultures. In comparisons of Japanese and Korean adults with same-age U.S. MIDUS participants, the Japanese and Koreans reported lower levels of psychological well-being, largely because they were less willing than the Americans to endorse individualistic traits, such as self-acceptance and autonomy, as characteristic of themselves (Karasawa et al.,  2011 ; Keyes & Ryff,  1998b ). Consistent with their collectivist orientation, Japanese and Koreans’ highest well-being scores were on positive relations with others. The Korean participants clarified that they viewed personal fulfillment as achieved through family, especially the success of children. Americans also regarded family relations as relevant to well-being but placed greater emphasis on their own traits and accomplishments than on their children’s.

Coping with Daily Stressors

In  Chapter 15 , we discussed the importance of stress management in preventing illness. It is also vital for psychological well-being. In a MIDUS satellite study in which more than 1,000 participants were interviewed on eight consecutive evenings, researchers found an early- to mid-adulthood plateau in frequency of daily stressors, followed by a decline as work and family responsibilities ease and leisure time increases (see  Figure 16.2 ) (Almeida & Horn,  2004 ). Women reported more frequent role overload (conflict among roles of employee, spouse, parent, and caregiver of an aging parent) and family-network and child-related stressors, men more work-related stressors, but both genders experienced all varieties. Compared with older people, young and midlife adults also perceived their stressors as more disruptive and unpleasant, perhaps because they often experienced several at once, and many involved financial risks and children.

But recall, also, from  Chapter 15  that midlife brings an increase in effective coping strategies. Middle-aged individuals are more likely to identify the positive side of difficult situations, postpone action to permit evaluation of alternatives, anticipate and plan ways to handle future discomforts, and use humor to express ideas and feelings without offending others (Diehl, Coyle, & Labouvie-Vief,  1996 ). Notice how these efforts flexibly draw on both problem-centered and emotion-centered strategies.

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FIGURE 16.2 Age-related changes in daily stressors among men and women.

In a MIDUS satellite study, researchers interviewed more than 1,000 adults on eight consecutive evenings. Findings revealed an early- to mid-adulthood plateau, followed by a decline as work and family responsibilities ease and leisure time increases.

(From D. M. Almeida & M. C. Horn, 2004, “Is Daily Life More Stressful During Middle Adulthood?” in O. G. Brim, C. D. Ruff, and R. C. Kessler [Eds.], How Healthy Are We? A National Study of Well-Being at Midlife. Chicago: The University of Chicago Press, p. 438. Adapted by permission of The University of Chicago Press.)

Why might effective coping increase in middle adulthood? Other personality changes seem to support it. Complex, integrated, coherent self-descriptions—which increase in midlife, indicating an improved ability to blend strengths and weaknesses into an organized picture—predict a stronger sense of personal control over outcomes and good coping strategies (Hay & Diehl,  2010 ; Labouvie-Vief & Diehl,  2000 ). Midlife gains in emotional stability and confidence in handling life’s problems may also contribute (Roberts et al.,  2007 ; Roberts & Mroczek,  2008 ). These attributes predict work and relationship effectiveness—outcomes that reflect the sophisticated, flexible coping of middle age.

Gender Identity

In her forties and early fifties, Trisha appeared more assertive at work. She spoke out more freely at meetings and took a leadership role when a team of lawyers worked on an especially complex case. She was also more dominant in family relationships, expressing her opinions to her husband and son more readily than she had 10 or 15 years earlier. In contrast, Devin’s sense of empathy and caring became more apparent, and he was less assertive and more accommodating to Trisha’s wishes than before.

Many studies report an increase in “masculine” traits in women and “feminine” traits in men across middle age (Huyck,  1990 ; James et al.,  1995 ). Women become more confident, self-sufficient, and forceful, men more emotionally sensitive, caring, considerate, and dependent. These trends appear in cross-sectional and longitudinal research, in people varying in SES, and in diverse cultures—not just Western industrialized nations but also village societies such as the Maya of Guatemala, the Navajo of the United States, and the Druze of the Middle East (Fry,  1985 ; Gutmann,  1977 ; Turner,  1982 ). Consistent with Levinson’s theory, gender identity in midlife becomes more androgynous—a mixture of “masculine” and “feminine” characteristics.

Although the existence of these changes is well-accepted, explanations for them are controversial. A well-known evolutionary view,  parental imperative theory , holds that identification with traditional gender roles is maintained during the active parenting years to help ensure the survival of children. Men become more goal-oriented, while women emphasize nurturance (Gutmann & Huyck,  1994 ). After children reach adulthood, parents are free to express the “other-gender” side of their personalities.

Biology and environment What Factors Promote Psychological Well-Being in Midlife?

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These yoga students express a sense of purpose and accomplishment. Maintaining an exercise regimen contributes greatly to midlife psychological well-being.

For Trisha and Devin, midlife brought contentment and high life satisfaction. But the road to happiness was rockier for Jewel, Tim, and Elena. What factors contribute to individual differences in psychological well-being at midlife? Consistent with the lifespan perspective, biological, psychological, and social forces are involved, and their effects are interwoven.

Good Health and Exercise

Good health affects energy and zest for life at any age. But during middle and late adulthood, taking steps to improve health and prevent disability becomes a better predictor of psychological well-being. Many studies confirm that engaging in regular exercise—walking, dancing, jogging, or swimming—is more strongly associated with self-rated health and a positive outlook in older than in younger adults (Bherer,  2012 ). Middle-aged people who maintain an exercise regimen are likely to perceive themselves as particularly active for their age and, therefore, to feel a special sense of accomplishment (Netz et al.,  2005 ). In addition, physical activity enhances self-efficacy and effective stress management (see  page 515 in  Chapter 15 ).

Sense of Control and Personal Life Investment

Middle-aged adults who report a high sense of control over events in various aspects of their lives—health, family, and work—also report more favorable psychological well-being. Sense of control contributes further to self-efficacy. It also predicts use of more effective coping strategies, including seeking of social support, and thereby helps sustain a positive outlook in the face of health, family, and work difficulties (Lachman, Neupert, & Agrigoroaei,  2011 ).

Personal life investment—firm commitment to goals and involvement in pursuit of those goals—also adds to mental health and life satisfaction (Staudinger & Bowen,  2010 ). According to Mihaly Csikszentmihalyi, a vital wellspring of happiness is flow—the psychological state of being so engrossed in a demanding, meaningful activity that one loses all sense of time and self-awareness. People describe flow as the height of enjoyment, even as an ecstatic state. The more people experience flow, the more they judge their lives to be gratifying (Nakamura & Csikszentmihalyi,  2009 ). Although flow is common in people engaged in creative endeavors, many others report it—students who love studying, employees who like their jobs, adults involved in challenging leisure pursuits, and parents and grandparents engaged in pleasurable learning activities with children. Flow depends on perseverance and skill at complex endeavors that offer potential for growth. These qualities are well-developed in middle adulthood.

Positive Social Relationships

Developing gratifying social ties is closely linked to midlife psychological well-being. In a survey of college alumni, those who preferred occupational prestige and high income to close friends were twice as likely as other respondents to describe themselves as “fairly” or “very” unhappy (Perkins,  1991 , as cited by Myers,  2000 ).

Supportive relationships, especially with friends and relatives, improve mental health by promoting positive emotions and protecting against stress (Fiori, Antonucci, & Cortina,  2006 ; Powdthavee,  2008 ). Enjoyable social ties can even strengthen the impact of an exercise regimen on well-being. Among an ethnically diverse sample of women using a private gym or an African Caribbean community center, exercising with likeminded companions contributed to their happiness and life satisfaction (Wray,  2007 ). The social side of going to the gym appeared especially important to minority women, who were less concerned with physical-appearance benefits than their Caucasian agemates.

A Good Marriage

Although friendships are important, a good marriage boosts psychological well-being even more. The role of marriage in mental health increases with age, becoming a powerful predictor by late midlife (Marks, Bumpass, & Jun,  2004 ; Marks & Greenfield,  2009 ).

Longitudinal studies tracking people as they move in and out of intimate relationships suggest that marriage actually brings about well-being. For example, when interviews with over 13,000 U.S. adults were repeated five years later, people who remained married reported greater happiness than those who remained single. Those who separated or divorced became less happy, reporting considerable depression (Marks & Lambert,  1998 ). Couples who married for the first time experienced a sharp increase in happiness, those who entered their second marriage a modest increase.

Although not everyone is better off married, the link between marriage and well-being is similar in many nations, suggesting that marriage changes people’s behavior in ways that make them better off (Diener et al.,  2000 ; Lansford et al.,  2005 ). Married partners monitor each other’s health and offer care in times of illness. They also earn and save more money than single people, and higher income is modestly linked to psychological well-being (Myers,  2000 ; Waite,  1999 ). Furthermore, sexual satisfaction predicts mental health, and married couples have more satisfying sex lives than singles (see  Chapter 13 ).

Mastery of Multiple Roles

Finally, success in handling multiple roles—spouse, parent, worker, community volunteer—is linked to psychological well-being. In the MIDUS survey, as role involvement increased, both men and women reported greater environmental mastery, more rewarding social relationships, heightened sense of purpose in life, and more positive emotion. Furthermore, adults who occupied multiple roles and who also reported high control (suggesting effective role management) scored especially high in well-being—an outcome that was stronger for less-educated adults (Ahrens & Ryff,  2006 ). Control over roles may be vital for individuals with lower educational attainment, whose role combinations may be particularly stressful and who have fewer economic resources.

Finally, among nonfamily roles, community volunteering in the latter part of midlife contributes uniquely to psychological well-being (Choi & Kim,  2011 ; Ryff et al.,  2012 ). It may do so by strengthening self-efficacy, generativity, and altruism.

But this biological account has been criticized. As we discussed in earlier chapters, parents need both warmth and assertiveness (in the form of firmness and consistency) to rear children effectively. And although children’s departure from the home is related to men’s openness to the “feminine” side of their personalities, the link to a rise in “masculine” traits among women is less apparent (Huyck,  1996 ,  1998 ). In longitudinal research, college-educated women in the labor force became more independent by their early forties, regardless of whether they had children; those who were homemakers did not. Women attaining high status at work gained most in dominance, assertiveness, and outspokenness by their early fifties (Helson & Picano,  1990 ; Wink & Helson,  1993 ). Furthermore, cohort effects can contribute to this trend: In one study, middle-aged women of the baby-boom generation—who experienced new career opportunities as a result of the women’s movement—more often described themselves as having masculine and androgynous traits than did older women (Strough et al.,  2007 ).

Additional demands of midlife may prompt a more androgynous orientation. For example, among men, a need to enrich a marital relationship after children have departed, along with reduced chances for career advancement, may be involved in the awakening of emotionally sensitive traits. Compared with men, women are far more likely to face economic and social disadvantages. A greater number remain divorced, are widowed, and encounter discrimination in the workplace. Self-reliance and assertiveness are vital for coping with these circumstances.

In sum, androgyny in midlife results from a complex combination of social roles and life conditions. In  Chapter 8 , we noted that androgyny predicts high self-esteem. In adulthood, it is also associated with cognitive flexibility, creativity, advanced moral reasoning, and psychosocial maturity (Prager & Bailey,  1985 ; Runco, Cramond, & Pagnani,  2010 ; Waterman & Whitbourne,  1982 ). People who integrate the masculine and feminine sides of their personalities tend to be psychologically healthier, perhaps because they are able to adapt more easily to the challenges of aging.

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In middle age, gender identity becomes more androgynous for both sexes. Men tend to show an increase in “feminine” traits, becoming more emotionally sensitive, caring, considerate, and dependent.

Individual Differences in Personality Traits

Although Trisha and Jewel both became more self-assured and assertive in midlife, in other respects they differed. Trisha had always been more organized and hard-working, Jewel more gregarious and fun-loving. Once, the two women traveled together. At the end of each day, Trisha was disappointed if she had not kept to a schedule and visited every tourist attraction. Jewel liked to “play it by ear”—wandering through streets and stopping to talk with shopkeepers and residents.

In previous sections, we considered personality changes common to many middle-aged adults, but stable individual differences also exist. Through factor analysis of self-report ratings, the hundreds of personality traits on which people differ have been reduced to five basic factors, often referred to as the  “big five” personality traits:  neuroticism, extroversion, openness to experience, agreeableness, and conscientiousness.  Table 16.1  provides a description of each. Notice that Trisha is high in conscientiousness, whereas Jewel is high in extroversion.

Longitudinal and cross-sectional studies of U.S. men and women reveal that agreeableness and conscientiousness increase from the teenage years through middle age, whereas neuroticism declines, and extroversion and openness to experience do not change or decrease slightly—changes that reflect “settling down” and greater maturity. Similar trends have been identified in more than fifty countries varying widely in cultural traditions, including Canada, Germany, Italy, Japan, Russia, and South Korea (McCrae & Costa,  2006 ; Roberts, Walton, & Viechtbauer,  2006 ; Schmitt et al.,  2007 ; Soto et al.,  2011 ; Srivastava et al.,  2003 ). The consistency of these cross-cultural findings has led some researchers to conclude that adult personality change is genetically influenced. They note that individual differences in the “big five” traits are large and highly stable: A person who scores high or low at one age is likely to do the same at another, over intervals ranging from 3 to 30 years (McCrae & Costa,  2006 ).

TABlE 16.1 The “Big Five” Personality Traits

TRAIT DESCRIPTION
Neuroticism Individuals who are high on this trait are worrying, temperamental, self-pitying, self-conscious, emotional, and vulnerable.
Extroversion Individuals who are high on this trait are affectionate, talkative, active, fun-loving, and passionate. Individuals who are low are reserved, quiet, passive, sober, and emotionally unreactive.
Openness to experience Individuals who are high on this trait are imaginative, creative, original, curious, and liberal. Individuals who are low are down-to-earth, uncreative, conventional, uncurious, and conservative.
Agreeableness Individuals who are high on this trait are soft-hearted, trusting, generous, acquiescent, lenient, and good-natured. Individuals who are low are ruthless, suspicious, stingy, antagonistic, critical, and irritable.
Conscientiousness Individuals who are high on this trait are conscientious, hard-working, well-organized, punctual, ambitious, and persevering. Individuals who are low are negligent, lazy, disorganized, late, aimless, and nonpersistent.

Source: McCrae, 2011; McCrae & Costa, 2006.

How can there be high stability in personality traits, yet significant changes in aspects of personality discussed earlier? Studies of the “big five” traits include very large samples and typically do not examine the impact of a host of contextual factors—including life events, the social clock, and cultural values—that shape aspirations, goals, and expectations for appropriate behavior (Caspi & Roberts,  2001 ). Look closely at the traits in  Table 16.1 , and you will see that they differ from the attributes considered in previous sections: They do not take into account motivations, preferred tasks, and coping styles, nor do they consider how certain aspects of personality, such as masculinity and femininity, are integrated. Theorists concerned with change due to experience focus on how personal needs and life events induce new strategies and goals; their interest is in “the human being as a complex adaptive system” (Block,  1995 ,  2011 , p. 19). In contrast, those who emphasize stability due to heredity measure personality traits on which individuals can easily be compared and that are present at any time of life.

To resolve this apparent contradiction, we can think of adults as changing in overall organization and integration of personality but doing so on a foundation of basic, enduring dispositions that support a coherent sense of self as people adapt to changing life circumstances. When more than 2,000 individuals in their forties were asked to reflect on their personalities during the previous six years, 52 percent said they had “stayed the same,” 39 percent said they had “changed a little,” and 9 percent said they had “changed a lot” (Herbst et al.,  2000 ). Again, these findings contradict a view of middle adulthood as a period of great turmoil and change. But they also underscore that personality remains an “open system,” responsive to the pressures of life experiences. Indeed, certain midlife personality changes may strengthen trait consistency! Improved self-understanding, self-acceptance, and skill at handling challenging situations may result in less need to modify basic personality dispositions over time.

ASK YOURSELF

REVIEW Summarize personality changes at midlife. How can these changes be reconciled with increasing stability of the “big five” personality traits?

CONNECT List cognitive gains that typically occur during middle adulthood. (See  Chapter 15 ,  pages 518 – 519  and  524 – 525 .) How might they support midlife personality changes?

APPLY Jeff, age 46, suggested to his wife, Julia, that they set aside time once a year to discuss their relationship—both positive aspects and ways to improve. Julia was surprised because Jeff had never before expressed interest in working on their marriage. What midlife developments probably fostered this new concern?

REFLECT List your hoped-for and feared possible selves. Then ask family members in early and middle adulthood to do the same. Are their reports consistent with age-related research findings? Explain.

image14 Relationships at Midlife

The emotional and social changes of midlife take place within a complex web of family relationships and friendships and an intensified personal focus on generative concerns. Although some middle-aged people live alone, the vast majority—87 percent in the United States—live in families, most with a spouse (U.S. Census Bureau,  2012b ). Partly because they have ties to older and younger generations in their families and partly because their friendships are well-established, people tend to have a larger number of close relationships during midlife than at any other period (Antonucci, Akiyama, & Takahashi,  2004 ).

The middle adulthood phase of the family life cycle is often referred to as “launching children and moving on.” In the past, it was called the “empty nest,” but this phrase implies a negative transition, especially for women who have devoted themselves entirely to their children and for whom the end of active parenting can trigger feelings of emptiness and regret. But for most people, middle adulthood is a liberating time, offering a sense of completion and opportunities to strengthen social ties and rekindle interests.

As our discussion in  Chapter 14  revealed, increasing numbers of young adults are living at home because of tight job markets and financial challenges, yielding launch–return–relaunch patterns for many middle-aged parents. Still, a declining birthrate and longer life expectancy mean that many contemporary parents do launch children a decade or more before retirement and then turn to other rewarding activities. As adult children depart and marry, middle-aged parents must adapt to new roles of parent-in-law and grandparent. At the same time, they must establish a different type of relationship with their aging parents, who may become ill or infirm and die.

Middle adulthood is marked by the greatest number of exits and entries of family members. Let’s see how ties within and beyond the family change during this time of life.

Marriage and Divorce

Although not all couples are financially comfortable, middle-aged households are well-off economically compared with other age groups. Americans between 45 and 54 have the highest average annual income. And the baby boomers—more of whom have earned college and postgraduate degrees and live in dual-earner families—are financially better off than previous midlife generations (Eggebeen & Sturgeon,  2006 ; U.S. Census Bureau,  2012b ). Partly because of increased education and financial security, the contemporary social view of marriage in midlife is one of expansion and new horizons.

These forces strengthen the need to review and adjust the marital relationship. For Devin and Trisha, this shift was gradual. By middle age, their marriage had permitted satisfaction of family and individual needs, endured many changes, and culminated in deeper feelings of love. Elena’s marriage, in contrast, became more conflict-ridden as her teenage daughter’s problems introduced added strains and as departure of children made marital difficulties more obvious. Tim’s failed marriage revealed yet another pattern. With passing years, the number of problems declined, but so did the love expressed (Rokach, Cohen, & Dreman,  2004 ). As less happened in the relationship, good or bad, the couple had little to keep them together.

As the Biology and Environment box on  pages 540 – 541  revealed, marital satisfaction is a strong predictor of midlife psychological well-being. Middle-aged men who have focused only on career often realize the limited nature of their pursuits. At the same time, women may insist on a more gratifying relationship. And children fully engaged in adult roles remind middle-aged parents that they are in the latter part of their lives, prompting many to decide that the time for improving their marriages is now (Berman & Napier,  2000 ).

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For many middle-aged couples, having forged a relationship that permits satisfaction of both family and individual needs results in deep feelings of love.

As in early adulthood, divorce is one way of resolving an unsatisfactory marriage in midlife. The divorce rate of U.S. 50-to 65-year-olds has doubled over the past two decades (Brown & Lin,  2012 ). Divorce at any age takes a heavy psychological toll, but midlifers seem to adapt more easily than younger people. A survey of more than 13,000 Americans revealed that following divorce, middle-aged men and women reported less decline in psychological well-being than their younger counterparts (Marks & Lambert,  1998 ). Midlife gains in practical problem solving and effective coping strategies may reduce the stressful impact of divorce.

Because the divorce rate is more than twice as great among remarried couples as among those in first marriages, about half of midlife divorces involve people who have had one or more previous unsuccessful marriages. Highly educated middle-aged adults are more likely to divorce, probably because their more comfortable economic circumstances make it easier to leave an unhappy marriage (Skaff,  2006 ). Nevertheless, for many women, marital breakup—especially when it is repeated—severely reduces standard of living (see  page 347  in  Chapter 10 ). For this reason, in midlife and earlier, it is a strong contributor to the  feminization of poverty —a trend in which women who support themselves or their families have become the majority of the adult population living in poverty, regardless of age and ethnic group. Because of weak public policies safeguarding families (see  Chapter 2 ), the gender gap in poverty is higher in the United States than in other Western industrialized nations (U.S. Census Bureau,  2012b ).

What do recently divorced middle-aged people say about why their marriages ended? Women frequently mention communication problems, inequality in the relationship, adultery, gradual distancing, substance abuse, physical and verbal abuse, or their own desire for autonomy. Men also bring up poor communication and sometimes admit that their “workaholic” lifestyle or emotional inattentiveness played a major role in their marital failure. Women are more likely than men to initiate divorce, and those who do fare somewhat better in psychological well-being. Men who initiate a split often already have another romantic involvement to turn to (Rokach, Cohen, & Dreman,  2004 ; Sakraida,  2005 ; Schneller & Arditti,  2004 ).

Longitudinal evidence reveals that middle-aged women who weather divorce successfully tend to become more tolerant, comfortable with uncertainty, nonconforming, and self-reliant in personality—factors believed to be fostered by divorce-forced independence. And both men and women reevaluate what they consider important in a healthy relationship, placing greater weight on equal friendship and less on passionate love than they had the first time. As in earlier periods, divorce represents both a time of trauma and a time of growth (Baum, Rahav, & Sharon,  2005 ; Schneller & Arditti,  2004 ). Little is known about long-term adjustment following divorce among middle-aged men, perhaps because most enter new relationships and remarry within a short time.

Changing Parent–Child Relationships

Parents’ positive relationships with their grown children are the result of a gradual process of “letting go,” starting in childhood, gaining momentum in adolescence, and culminating in children’s independent living. As noted earlier, most parents “launch” adult children sometime in midlife. But because more people are delaying having children to their thirties and even forties (see  page 438  in  Chapter 13 ), the age at which midlifers experience their children’s departure varies widely. Most parents adjust well; only a minority have difficulty (Mitchell & Lovegreen,  2009 ). Investment in nonparental relationships and roles, children’s characteristics, parents’ marital and economic circumstances, and cultural forces affect the extent to which this transition is expansive and rewarding or sad and distressing.

After their son Mark secured a career-entry job and moved out of the family home permanently, Devin and Trisha felt a twinge of nostalgia combined with a sense of pride in their grown son’s maturity and success. Beyond this, they returned to rewarding careers and community participation and delighted in having more time for each other. Parents who have developed gratifying alternative activities typically welcome their children’s adult status (Mitchell & Lovegreen,  2009 ). A strong work orientation, especially, predicts gains in life satisfaction after children depart from the home (Silverberg,  1996 ).

Wide cultural variations exist in the social clock for children’s departure. Recall from  Chapter 13  that many young people from low-SES homes and with cultural traditions of extended-family living do not leave home early. In the Southern European countries of Greece, Italy, and Spain, parents often actively delay their children’s leaving. In Italy, for example, parents believe that moving out without a “justified” reason signifies that something is wrong in the family. Hence, many more Italian young adults reside with their parents until marriage than in other Western nations. At the same time, Italian adults grant their grown children extensive freedom within the parental home (Rusconi,  2004 ). Parent–adult-child relationships are usually positive, making living with parents attractive.

With the end of parent–child coresidence comes a substantial decline in parental authority. Devin and Trisha no longer knew of Mark’s daily comings and goings or expected him to inform them. Nevertheless, Mark telephoned at regular intervals to report on events in his life and seek advice about major decisions. Although the parental role changes, its continuation is important to middle-aged adults. Departure of children is a relatively minor event as long as parent–child contact and affection are sustained (Mitchell & Lovegreen,  2009 ). When it results in little or no communication, parents’ psychological well-being declines.

Whether or not they reside with parents, adolescent and young-adult children who are “off-time” in development—who deviate from parental expectations about how the path to adult responsibilities should unfold—can prompt parental strain (Pillemer & Suitor,  2002 ; Settersten,  2003 ). Consider Elena, whose daughter was doing poorly in her college courses and in danger of not graduating. The need for extensive parental guidance, at a time when she expected her daughter to be more responsible and independent, caused anxiety and unhappiness for Elena, who was ready to reduce time devoted to active parenting.

In one study, researchers asked a large sample of 40-to 60-year-old parents to report on their grown children’s problems and successes along with their own psychological well-being. Consistent with the familiar saying, “parents are only as happy as their least happy child,” having even one problematic child dampened parents’ well-being, but having a successful child did not have a compensating positive effect. The more grown children with problems, the poorer parents’ well-being. In contrast, it took multiple successful grown children to sway parents’ well-being in a favorable direction (Fingerman et al.,  2012a ). As with marriages, negative, conflict-ridden experiences with grown children are particularly salient, profoundly affecting midlife parents’ psychological states.

Throughout middle adulthood, parents continue to give more assistance to children than they receive, especially while children are unmarried or when they face difficulties, such as marital breakup or unemployment (Ploeg et al.,  2004 ; Zarit & Eggebeen,  2002 ). Support in Western countries typically flows “downstream”: Although ethnic variations exist, most middle-aged parents provide more financial, practical, emotional, and social support to their offspring than to their aging parents, unless a parent has an urgent need (declining health or other crises) (Fingerman & Birditt,  2011 ; Fingerman et al.,  2011a ). In explaining their generous support of adult children, parents usually mention the importance of the relationship. And providing adult children with assistance enhances midlife psychological well-being (Marks & Greenfield,  2009 ). Clearly, middle-aged adults remain invested in their adult children’s development and continue to reap deep personal rewards from the parental role.

When children marry, parents must adjust to an enlarged family network that includes in-laws. Difficulties occur when parents do not approve of their child’s partner or when the young couple adopts a way of life inconsistent with parents’ values. Parents who take steps to forge a positive tie with a future daughter- or son-in-law generally experience a closer relationship after the couple marries (Fingerman et al.,  2012b ). And when warm, supportive relationships endure, intimacy between parents and children increases over the adult years, with great benefits for parents’ life satisfaction (Ryff, Singer, & Seltzer,  2002 ). Members of the middle generation, especially mothers, usually take on the role of  kinkeeper, gathering the family for celebrations and making sure everyone stays in touch.

Parents of adult children expect a mature relationship, marked by tranquility and contentment. Yet many factors—on both the child’s and the parent’s side—affect whether that goal is achieved. Applying What We Know on  page 546  suggests ways middle-aged parents can increase the chances that bonds with adult children will be loving and rewarding and serve as contexts for personal growth.

Grandparenthood

Two years after Mark married, Devin and Trisha were thrilled to learn that a granddaughter was on the way. Although the stereotypical image of grandparents as elderly persists, today the average age of becoming a grandparent is 50 years for American women, 52 for American men (Legacy Project,  2012 ). A longer life expectancy means that many adults will spend one-third or more of their lifespan in the grandparent role.

Meanings of Grandparenthood.

Middle-aged adults typically rate grandparenthood as highly important, following closely behind the roles of parent and spouse but ahead of worker, son or daughter, and sibling (Reitzes & Mutran,  2002 ). Why did Trisha and Devin, like many others their age, greet the announcement of a grandchild with such enthusiasm? Most people experience grandparenthood as a significant milestone, mentioning one or more of the following gratifications:

· ● Valued elder—being perceived as a wise, helpful person

· ● Immortality through descendants—leaving behind not just one but two generations after death

· ● Reinvolvement with personal past—being able to pass family history and values to a new generation

· ● Indulgence—having fun with children without major child-rearing responsibilities (AARP,  2002 ; Hebblethwaite & Norris,  2011 )

Applying What We Know Ways Middle-Aged Parents Can Promote Positive Ties with Their Adult Children

Suggestion Description
Emphasize positive communication. Let adult children and their intimate partners know of your respect, support, and interest. This not only communicates affection but also permits conflict to be handled in a constructive context.
Avoid unnecessary comments that are a holdover from childhood. Adult children, like younger children, appreciate an age-appropriate relationship. Comments that have to do with safety, eating, and self-care (“Be careful on the freeway,” “Don’t eat those foods,” “Make sure you wear a sweater—it’s cold out today”) annoy adult children and can stifle communication.
Accept the possibility that some cultural values and practices and aspects of lifestyle will be modified in the next generation. In constructing a personal identity, most adult children have gone through a process of evaluating the meaning of cultural values and practices for their own lives. Traditions and lifestyles cannot be imposed on adult children.
When an adult child encounters difficulties, resist the urge to “fix” things. Accept the fact that no meaningful change can take place without the willing cooperation of the adult child. Stepping in and taking over communicates a lack of confidence and respect. Find out whether the adult child wants your help, advice, and decision-making skills.
Be clear about your own needs and preferences. When it is difficult to arrange for a visit, babysit, or provide other assistance, say so and negotiate a reasonable compromise rather than letting resentment build.

Grandparent–Grandchild Relationships.

Grandparents’ styles of relating to grandchildren vary as widely as the meanings they derive from their new role. The grandparent’s and grandchild’s age and sex make a difference. When their granddaughter was young, Trisha and Devin enjoyed an affectionate, playful relationship with her. As she got older, she looked to them for information and advice in addition to warmth and caring. By the time their granddaughter reached adolescence, Trisha and Devin had become role models, family historians, and conveyers of social, vocational, and religious values.

Living nearby is the strongest predictor of frequent, face-to-face interaction with young grandchildren. Despite high family mobility in Western industrialized nations, most grandparents live close enough to at least one grandchild to enable regular visits. But because time and resources are limited, number of “grandchild sets” (households with grandchildren) reduces grandparent visits (Uhlenberg & Hammill,  1998 ). A strong desire to affect the development of grandchildren can motivate grandparents’ involvement. As grandchildren get older, distance becomes less influential and relationship quality more so: The extent to which adolescent or young-adult grandchildren believe their grandparent values contact is a good predictor of a close bond (Brussoni & Boon,  1998 ).

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Many grandparents derive great joy from an affectionate, playful relationship with young grandchildren. As this grandchild gets older, he may look to his grandfather for advice, as a role model, and for family history in addition to warmth and caring.

© BLUE JEAN IMAGES/ALAMY

As  Figure 16.3  shows, maternal grandmothers report more frequent visits with grandchildren than do paternal grandmothers, who are slightly advantaged over both maternal and paternal grandfathers (Uhlenberg & Hammill,  1998 ). Typically, relationships are closer between grandparents and grandchildren of the same sex and, especially, between maternal grandmothers and granddaughters—a pattern found in many countries (Brown & Rodin,  2004 ). Grandmothers also report higher satisfaction with the grandparent role than grandfathers, perhaps because grandmothers are more likely to participate in recreational, religious, and family activities with grandchildren (Reitzes & Mutran,  2004 ; Silverstein & Marenco,  2001 ). The grandparent role may be a vital means through which women satisfy their kinkeeping function.

SES and ethnicity also influence grandparent–grandchild ties. In higher-income families, where the grandparent role is not central to family maintenance and survival, it is fairly unstructured and takes many forms. In low-income families, by contrast, grandparents often perform essential activities. For example, many single parents live with their families of origin and depend on grandparents’ financial and caregiving assistance to reduce the impact of poverty. Compared with grandchildren in intact families, grandchildren in single-parent and stepparent families report engaging in more diverse, higher-quality activities with their grandparents (Kennedy & Kennedy,  1993 ). As children experience the stress of family transition, bonds with grandparents take on increasing importance.

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FIGURE 16.3 Influence of grandparent sex and lineage on frequent visiting of grandchildren.

When a nationally representative sample of 4,600 U.S. grandparents were asked how often they visited a particular set of grandchildren, maternal grandmothers were especially likely to report visiting frequently (at least once a week). Paternal grandmothers slightly exceeded both maternal and paternal grandfathers.

(From P. Uhlenberg & B. G. Hammill, 1998, “Frequency of Grandparent Contact with Grandchild Sets: Six Factors That Make a Difference,” Gerontologist, 38, p. 281. Copyright © 1998 The Gerontological Society of America. Reprinted by permission of Oxford University Press and Peter Uhlenberg.)

In some cultures, grandparents are absorbed into an extended-family household and become actively involved in child rearing. When a Chinese, Korean, or Mexican-American maternal grandmother is a homemaker, she is the preferred caregiver while parents of young children are at work (Kamo,  1998 ; Williams & Torrez,  1998 ). Similarly, involvement in child care is high among Native-American grandparents. In the absence of a biological grandparent, an unrelated aging adult may be integrated into the family to serve as a mentor and disciplinarian for children (Werner,  1991 ). (See  Chapter 2 ,  page 66 , for a description of the grandmother’s role in the African-American extended family.)

Increasingly, grandparents have stepped in as primary caregivers in the face of serious family problems. As the Social Issues: Health box on  page 548  reveals, a rising number of American children live apart from their parents in grandparent-headed households. Despite their willingness to help and their competence at child rearing, grandparents who take full responsibility for young children experience considerable emotional and financial strain. They need more assistance from community and government agencies than is currently available.

Because parents usually serve as gatekeepers of grandparents’ contact with grandchildren, relationships between grandparents and their daughter-in-law or son-in-law strongly affect the closeness of grandparent–grandchild ties. A positive bond with a daughter-in-law seems particularly important in the relationship between grandparents and their son’s children (Fingerman,  2004 ). And after a marital breakup, grandparents who are related to the custodial parent (typically the mother) have more frequent contact with grandchildren.

When family relationships are positive, grandparenthood provides an important means of fulfilling personal and societal needs in midlife and beyond. Typically, grandparents are a frequent source of pleasure, support, and knowledge for children, adolescents, and young adults. They also provide the young with firsthand experience in how older people think and function. In return, grandchildren become deeply attached to grandparents and keep them abreast of social change. Clearly, grand-parenthood is a vital context for sharing between generations.

Middle-Aged Children and Their Aging Parents

The percentage of middle-aged Americans with living parents has risen dramatically—from 10 percent in 1900 to over 50 percent in the first decade of the twenty-first century (U.S. Census Bureau,  2012b ). A longer life expectancy means that adult children and their parents are increasingly likely to grow old together. What are middle-aged children’s relationships with their aging parents like? And how does life change for adult children when an aging parent’s health declines?

Frequency and Quality of Contact.

A widespread myth is that adults of past generations were more devoted to their aging parents than are today’s adults. Although adult children spend less time in physical proximity to their parents, the reason is not neglect or isolation. Because of a desire to be independent, made possible by gains in health and financial security, fewer aging adults live with younger generations now than in the past. Nevertheless, approximately two-thirds of older adults in the United States live close to at least one of their children, and frequency of contact is high through both visits and telephone calls (U.S. Census Bureau,  2012b ). Proximity increases with age: Aging adults who move usually do so in the direction of kin, and younger people tend to move in the direction of their aging parents.

Middle age is a time when adults reassess relationships with their parents, just as they rethink other close ties. Many adult children become more appreciative of their parents’ strengths and generosity and mention positive changes in the quality of the relationship, even after parents show physical declines. A warm, enjoyable relationship contributes to both parent and adult-child well-being (Fingerman et al.,  2007 ,  2008 ; Pudrovska,  2009 ). Trisha, for example, felt closer to her parents and often asked them to tell her more about their earlier lives.

Social Issues: Health Grandparents Rearing Grandchildren: The Skipped-Generation Family

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A custodial grandmother helps her 8-year-old granddaughter with homework. Although grandparents usually assume the parenting role under highly stressful circumstances, most find compensating rewards in rearing grandchildren.

Nearly 2.4 million U.S. children—4 to 5 percent of the child population—live with grandparents but apart from parents, in  skipped-generation families  (U.S. Census Bureau,  2012b ). The number of grandparents rearing grandchildren has increased over the past two decades. The arrangement occurs in all ethnic groups, though more often in African-American, Hispanic, and Native-American families than in Caucasian families. Although grandparent caregivers are more likely to be women than men, many grandfathers participate (Fuller-Thomson & Minkler,  2005 ,  2007 ; Minkler & Fuller-Thomson,  2005 ). Grandparents generally step in when parents’ troubled lives—as a result of substance abuse, child abuse and neglect, family violence, or physical or mental illness—threaten children’s well-being (Langosch,  2012 ). Often these families take in two or more children.

As a result, grandparents usually assume the parenting role under highly stressful life circumstances. Unfavorable child-rearing experiences have left their mark on the children, who show high rates of learning difficulties, depression, and antisocial behavior. Absent parents’ adjustment difficulties strain family relationships. Parents may interfere by violating the grandparents’ behavioral limits, taking grandchildren away without permission, or making promises to children that they do not keep. These youngsters also introduce financial burdens into households that often are already low-income (Mills, Gomez-Smith, & De Leon,  2005 ; Williamson, Softas-Nall, & Miller,  2003 ). All these factors heighten grandparents’ emotional distress.

Grandparents struggle with daily dilemmas—wanting to be grandparents, not parents; wanting the parent to be present in the child’s life but fearing for the child’s well-being if the parent returns and does not provide good care (Templeton,  2011 ). And grandparent caregivers, at a time when they anticipated having more time for spouses, friends, and leisure, instead have less. Many report feeling emotionally drained, depressed, and worried about what will happen to the children if their own health fails (Hayslip & Kaminski,  2005 ; Langosch,  2012 ). Some families are extremely burdened. Native-American care-giving grandparents are especially likely to be unemployed, to have a disability, to be caring for several grandchildren, and to be living in extreme poverty (Fuller-Thomson & Minkler,  2005 ).

Despite great hardship, these grandparents seem to realize their widespread image as “silent saviors,” often forging close emotional bonds with their grandchildren and using effective child-rearing practices (Fuller-Thomson & Minkler,  2000 ; Gibson,  2005 ). Compared with children in divorced, single-parent families, blended families, or foster families, children reared by grandparents fare better in adjustment (Rubin et al.,  2008 ; Solomon & Marx,  1995 ).

Skipped-generation families have a tremendous need for social and financial support and intervention services for troubled children. Custodial grandparents describe support groups—both for themselves and for their grandchildren—as especially helpful, yet only a minority make use of such interventions (Smith, Rodriguez, & Palmieri,  2010 ). This suggests that grandparents need special help in finding out about and accessing support services.

Although their everyday lives are often stressful, caregiving grandparents—even those rearing children with serious problems—report as much fulfillment in the grandparent role as typical grandparents do (Hayslip et al.,  2002 ). The warmer the grandparent–grandchild bond, the greater grandparents’ long-term life satisfaction (Goodman,  2012 ). Many grandparents mention joy from sharing children’s lives and feelings of pride at children’s progress, which help compensate for difficult circumstances. And some grandparents view the rearing of grandchildren as a “second chance”—an opportunity to make up for earlier, unfavorable parenting experiences and “do it right” (Dolbin-MacNab,  2006 ).

Research indicates that middle-aged daughters forge closer, more supportive relationships with aging parents, especially mothers, than do middle-aged sons (Fingerman,  2003 ). But this gender difference may be declining. Sons report closer ties and greater assistance to aging parents in recent than in previous studies (Fingerman et al.,  2007 ,  2008 ). Changing gender roles are likely responsible. Because the majority of contemporary middle-aged women are employed, they face many competing demands on their time and energy. Consequently, men are becoming more involved in family responsibilities, including with aging parents (Fingerman & Birditt,  2011 ). Despite this shift, women’s investment continues to exceed men’s.

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In midlife, many adults develop warmer, more supportive relationships with their aging parents. At a birthday party for her mother, this daughter expresses love and appreciation for her mother’s strengths and generosity.

In collectivist cultures, older adults most often live with their married children. For example, traditionally, Chinese, Japanese, and Korean seniors moved in with a son and his wife and children; today, many live with a daughter and her family, too. This tradition of coresidence, however, is declining in some parts of Asia and in the United States, as more Asian and Asian-American aging adults choose to live on their own (Davey & Takagi,  2013 ; Zhan & Montgomery,  2003 ; Zhang,  2004 ). In African-American and Hispanic families as well, coresidence is common. Regardless of whether coresidence and daily contact are typical, relationship quality usually reflects patterns established earlier: Positive parent–child ties generally remain so, as do conflict-ridden interactions.

Help exchanged between adult children and their aging parents is responsive to past and current family circumstances. The more positive the history of the parent–child tie, the more help given and received. Also, aging parents give more help to unmarried adult children and to those with disabilities. Similarly, adult children give more to elderly parents who are widowed or in poor health—usually emotional support and practical help, less often financial assistance. At the same time, middle-aged parents do what they can to maximize the overall quantity of help offered, as needed: While continuing to provide generous assistance to their children because of the priority placed on the parent–child tie (see  page 545 ), middle-aged adults augment the aid they give to elderly parents as parental health problems increase (Kunemund, Motel-Klingebiel, & Kohli,  2005 ; Stephens et al.,  2009 ).

Even when parent–child relationships have been emotionally distant, adult children offer more support as parents age, out of a sense of altruism and family duty (Silverstein et al.,  2002 ). And although the baby-boom generation is often described as self-absorbed, baby-boom midlifers actually express a stronger commitment to caring for their aging parents than the preceding middle-aged generation (Gans & Silverstein,  2006 ).

In sum, as long as multiple roles are manageable and the experiences within each are high in quality, midlife intergenerational assistance as family members (aging parents) have increased needs is best characterized as resource expansion rather than as merely conflicting demands that inevitably drain energy and detract from psychological well-being (Grundy & Henretta,  2006 ; Stephens et al.,  2009 ). Recall from the Biology and Environment box on  pages 540 – 541  that midlifers derive great personal benefits from successfully managing multiple roles. Their enhanced self-esteem, mastery, and sense of meaning and purpose expand their motivation and energy to handle added family-role demands, from which they reap additional personal rewards.

Caring for Aging Parents.

About 25 percent of U.S. adult children provide unpaid care to an aging adult (MetLife,  2011 ). The burden of caring for aging parents can be great. In  Chapter 2 , we noted that as birthrates have declined, the family structure has become increasingly “top-heavy,” with more generations alive but fewer younger members. Consequently, more than one older family member is likely to need assistance, with fewer younger adults available to provide it.

The term  sandwich generation  is widely used to refer to the idea that middle-aged adults must care for multiple generations above and below them at the same time (Riley & Bowen,  2005 ). Although only a minority of contemporary middle-aged adults who care for aging parents have children younger than age 18 at home, many are providing assistance to young-adult children and to grandchildren—obligations that, when combined with work and community responsibilities, can lead middle-aged caregivers to feel “sandwiched,” or squeezed, between the pressures of older and younger generations. As more baby boomers move into late adulthood and as their adult children continue to delay childbearing, the number of midlifers who are working, rearing young children, and caring for aging parents will increase.

Middle-aged adults living far from aging parents who are in poor health often substitute financial help for direct care, if they have the means. But when parents live nearby and have no spouse to meet their needs, adult children usually engage in direct care. Regardless of family income level, African-American, Asian-American, and Hispanic adults give aging parents more direct care and financial help than Caucasian-American adults do (Shuey & Hardy,  2003 ). Compared with their white counterparts, African Americans and Hispanics express a stronger sense of obligation, and find it more personally rewarding, to support their aging parents (Fingerman et al.,  2011b ; Swartz,  2009 ). And African Americans often draw on close, family-like relationships with friends and neighbors for caregiving assistance.

In all ethnic groups, responsibility for providing care to aging parents falls more on daughters than on sons. Why are women usually the principal caregivers? Families turn to the person who seems most available—living nearby and with fewer commitments that might interfere with the ability to assist. These unstated rules, in addition to parents’ preference for same-sex caregivers (aging mothers live longer), lead more women to fill the role (see  Figure 16.4 ). Daughters also feel more obligated than sons to care for aging parents (Gans & Silverstein,  2006 ; Stein,  2009 ). And although couples strive to be fair to both sides of the family, they tend to provide more direct care for the wife’s parents. This bias, however, is weaker in ethnic minority families and is nonexistent in Asian nations where cultural norms specify that daughters-in-law provide care to their husband’s parents (Shuey & Hardy,  2003 ; Zhan & Montgomery,  2003 ).

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Caring for an aging parent with a chronic illness or disability is highly stressful. But social support reduces physical and emotional strain, enabling adult children to find satisfactions and rewards in tending to parents’ needs.

As  Figure 16.4  shows, nearly one-fourth of American working women are caregivers; others quit their jobs to provide care. And the time they devote to caring for a disabled aging parent is substantial, averaging 10 to 20 hours per week (Metlife,  2011 ; Takamura & Williams,  2004 ). Nevertheless, men—although doing less than women—do contribute. In one investigation, employed men spent an average of 7½ hours per week caring for parents or parents-in-law (Neal & Hammer,  2007 ). Tim, for example, looked in on his father, a recent stroke victim, every evening, reading to him, running errands, making household repairs, and taking care of finances. His sister, however, provided more hands-on care—cooking, feeding, bathing, managing medication, and doing laundry. The care sons and daughters provide tends to be divided along gender-role lines. About 10 percent of the time—generally when no other family member can do so—sons become primary caregivers, heavily involved in basic-care tasks (Harris,  1998 ; Pinquart & Sörensen,  2006 ).

As adults move from early to later middle age, the sex difference in parental caregiving declines. Perhaps as men reduce their vocational commitments and feel less need to conform to a “masculine” gender role, they grow more able and willing to provide basic care (Marks,  1996 ; MetLife,  2011 ). At the same time, parental caregiving may contribute to men’s greater openness to the “feminine” side of their personalities. A man who cared for his mother, severely impaired by Alzheimer’s disease, commented on how the experience altered his outlook: “It was so difficult to do these tasks; things a man, a son, is not supposed to do. I have definitely modified my views on conventional expectations” (Hirsch,  1996 , p. 112).

Although most adult children help willingly, caring for a chronically ill or disabled parent is highly stressful. Over time, the parent usually gets worse, and the caregiving task escalates. As Tim explained to Devin and Trisha, “One of the hardest aspects is the emotional strain of seeing my father’s physical and mental decline up close.”

Caregivers who share a household with ill parents—about 23 percent of U.S. adult children—experience the most stress. When a parent and child who have lived separately for years must move in together, conflicts generally arise over routines and lifestyles. But the greatest source of stress is problem behavior, especially for caregivers of parents who have deteriorated mentally (Alzheimer’s Association,  2012b ). Tim’s sister reported that their father would wake during the night, ask repetitive questions, follow her around the house, and become agitated and combative.

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FIGURE 16.4 Baby boomers, by work status and gender, who provide basic personal care to an aging parent in poor health.

A survey of a nationally representative sample of 1,100 U.S. men and women over age 50 with at least one parent living revealed that more nonworking than working adults engaged in basic personal care (assistance with such activities as dressing, feeding, and bathing). Regardless of work status, many more women than men were caregivers.

(Adapted from The MetLife Study of Caregiving Costs to Working Caregivers: Double Jeopardy for Baby Boomers Caring for Their Parents, June 2011, Figure 3. Reprinted by permission of The MetLife Mature Market Institute, New York, NY.)

Applying What We Know Relieving the Stress of Caring for an Aging Parent

Strategy Description
Use effective coping strategies. Use problem-centered coping to manage the parent’s behavior and caregiving tasks. Delegate responsibilities to other family members, seek assistance from friends and neighbors, and recognize the parent’s limits while calling on capacities the parent does have. Use emotion-centered coping to reinterpret the situation in a positive way, such as emphasizing the opportunity it offers for personal growth and for giving to parents in the last years of their lives. Avoid denial of anger, depression, and anxiety in response to the caregiving burden, which heightens stress.
Seek social support. Confide in family members and friends about the stress of caregiving, seeking their encouragement and help. So far as possible, avoid quitting work to care for an ill parent; doing so is associated with social isolation and loss of financial resources.
Make use of community resources. Contact community organizations to seek information and assistance, in the form of caregiver support groups, in-home respite help, home-delivered meals, transportation, and adult day care.
Press for workplace and public policies that relieve the emotional and financial burdens of caring for an aging parent. Encourage your employer to provide care benefits, such as flexible work hours and employment leave for caregiving. Communicate with lawmakers and other citizens about the need for additional government funding to help pay for caregiving. Emphasize the need for improved health insurance plans that reduce the financial strain of caring for an aging parent on middle- and low-income families.

Parental caregiving often has emotional, physical, and financial consequences. It leads to role overload, high job absenteeism, exhaustion, inability to concentrate, feelings of hostility, anxiety about aging, and high rates of depression, with women more profoundly affected than men (Neal & Hammer,  2007 ; Pinquart & Sörensen,  2006 ). Caregivers who must reduce their employment hours or leave the labor force to provide care (mostly women) face not just lost wages but also diminished retirement benefits. Despite having more time to care for an ill parent, women who quit work fare especially poorly in adjustment, probably because of social isolation and financial strain (Bookman & Kimbrel,  2011 ). Positive experiences at work can actually reduce the stress of parental care as caregivers bring a favorable self-evaluation and a positive mood home with them.

In cultures and subcultures where adult children feel an especially strong sense of obligation to care for aging parents, the emotional toll is also high (Knight & Sayegh,  2010 ). In research on Korean, Korean-American, and Caucasian-American caregivers of parents with mental disabilities, the Koreans and Korean Americans reported higher levels of family obligation and care burden—and also higher levels of anxiety and depression—than the Caucasian Americans (Lee & Farran,  2004 ; Youn et al.,  1999 ). And among African-American care-givers, women who strongly endorsed cultural reasons for providing care (“It’s what my people have always done”) fared less well in mental health two years later than women who moderately endorsed cultural reasons (Dilworth-Anderson, Goodwin, & Williams,  2004 ).

Social support is highly effective in reducing caregiver stress. Tim’s encouragement, assistance, and willingness to listen helped his sister cope with in-home care of their father so that she could find satisfactions in it. When caregiving becomes a team effort with multiple family members trading off, care-givers cope more effectively. Under these conditions, despite being demanding and stressful, it can enhance psychological well-being (Roberto & Jarrott,  2008 ). Adult children feel gratified at having helped and gain in self-understanding, problem solving, and sense of competence.

LOOK AND LISTEN

Ask a middle-aged adult caring for an aging parent in declining health to describe both the stressful and rewarding aspects of caregiving. What strategies does he or she use to reduce stress? To what extent does the caregiver share caregiving burdens with family members and enlist the support of community organizations?

In Denmark, Sweden, and Japan, a government-sponsored home helper system eases the burden of parental care by making specially trained nonfamily caregivers available, based on seniors’ needs (Saito, Auestad, & Waerness,  2010 ). In the United States, in-home care by a nonfamily caregiver is too costly for most families; only 10 to 20 percent arrange it (Family Caregiver Alliance,  2009 ). And unless they must, few people want to place their parents in formal care, such as nursing homes, which also are expensive. Applying What We Know above summarizes ways to relieve the stress of caring for an aging parent—at the individual, family, community, and societal levels. We will address additional care options, along with interventions for caregivers, in  Chapter 17 .

Siblings

As Tim’s relationship with his sister reveals, siblings are ideally suited to provide social support. Nevertheless, a survey of a large sample of ethnically diverse Americans revealed that sibling contact and support decline from early to middle adulthood, rebounding only after age 70 for siblings living near each other (White,  2001 ). Decreased midlife contact is probably due to the demands of middle-aged adults’ diverse roles. However, most adult siblings report getting together or talking on the phone at least monthly (Antonucci, Akiyama, & Merline,  2002 ).

Despite reduced contact, many siblings feel closer in mid-life, often in response to major life events (Stewart et al.,  2001 ). Launching and marriage of children seem to prompt siblings to think more about each other. As Tim commented, “It helped our relationship when my sister’s children were out of the house and married. I’m sure she cared about me. I think she just didn’t have time!” When a parent becomes seriously ill, brothers and sisters who previously had little to do with one another may find themselves in touch about parental care. And when parents die, adult children realize they have become the oldest generation and must look to each other to sustain family ties.

Not all sibling bonds improve, of course. Recall Trisha’s negative encounters with her sister, Dottie (see  page 513  in  Chapter 15 ). Dottie’s difficult temperament had made her hard to get along with since childhood, and her temper flared when their father died and problems arose over family finances. Large inequities in division of labor in parental caregiving can also unleash intense sibling conflict (Silverstein & Giarrusso,  2010 ). As siblings grow older, good relationships often get better and poor relationships get worse.

As in early adulthood, sister–sister relationships are closer than sister–brother and brother–brother ties, a difference apparent in many industrialized nations (Cicirelli,  1995 ; Fowler,  2009 ). But a comparison of middle-aged men of the baby-boom generation with those of the preceding cohort revealed warmer, more expressive ties between baby-boom brothers (Bedford & Avioli,  2006 ). A contributing factor may be baby boomers’ more flexible gender-role attitudes.

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These brothers, both in their fifties, express their mutual affection at a family reunion. Even when they have only limited contact, siblings often feel closer in midlife.

In industrialized nations, sibling relationships are voluntary. In village societies, they are generally involuntary and basic to family functioning. For example, among Asian Pacific Islanders, family social life is organized around strong brother–sister attachments. A brother–sister pair is often treated as a unit in exchange marriages with another family. After marriage, brothers are expected to protect sisters, and sisters serve as spiritual mentors to brothers. Families not only include biological siblings but bestow on other relatives, such as cousins, the status of brother or sister, creating an unusually large network of lifelong sibling support (Cicirelli,  1995 ). Cultural norms reduce sibling conflict, thereby ensuring family cooperation. In industrialized nations, promoting positive sibling ties in childhood is vital for warm sibling bonds in later years.

Friendships

As family responsibilities declined in middle age, Devin found he had more time to spend with friends. On Friday afternoons, he met several male friends at a coffee house, and they chatted for a couple of hours. But most of Devin’s friendships were couple-based—relationships he shared with Trisha. Compared with Devin, Trisha more often got together with friends on her own.

Middle-aged friendships reflect the same trends discussed in  Chapter 14 . At all ages, men’s friendships are less intimate than women’s. Men tend to talk about sports, politics, and business, whereas women focus on feelings and life problems. Women report a greater number of close friends and say they both receive and provide their friends with more emotional support (Antonucci, Akiyama, & Takahashi,  2004 ).

Over the past decade, the average number of friendships rose among U.S. midlifers, perhaps because of ease of keeping in touch through social media (Wang & Wellman,  2010 ). Though falling short of young adults’ use, connecting regularly with friends through Facebook or other social networking sites has risen rapidly among middle-aged adults (see  Figure 16.5 ) (Brenner,  2013 ; Hampton et al.,  2011 ). As in early adulthood, women are more active users. And users have more offline close relationships, sometimes using Facebook to revive “dormant” friendships.

Still, for both sexes, number of friends declines from middle to late adulthood, probably because people become less willing to invest in nonfamily ties unless they are very rewarding. As selectivity of friendship increases, older adults try harder to get along with friends (Antonucci & Akiyama,  1995 ). Having chosen a friend, middle-aged people attach great value to the relationship and take extra steps to protect it.

LOOK AND LISTEN

Ask a middle-aged couple you know well to describe the number and quality of their friendships today compared with their friendships in early adulthood. Does their report match research findings? Explain.

By midlife, family relationships and friendships support different aspects of psychological well-being. Family ties protect against serious threats and losses, offering security within a long-term timeframe. In contrast, friendships serve as current sources of pleasure and satisfaction, with women benefiting somewhat more than men (Levitt & Cici-Gokaltun,  2011 ). As middle-aged couples renew their sense of companionship, they may combine the best of family and friendship.

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FIGURE 16.5 Gains in use of social networking sites by age group from 2005 to 2012.

Repeated surveys of large representative samples of U.S. adults who use the Internet revealed that social networking site use increased substantially for all age groups. Though not as avid users as young adults, most middle-aged adults use social networking sites, primarily Facebook.

(From J. Brenner, 2013, “Pew Internet: Social Networking.” Pew Research Center’s Internet & American Life Project, Washington, D.C. February 14, 2013,  www.pewinternet.org . Adapted by permission.)

ASK YOURSELF

REVIEW How do age, sex, proximity, and culture affect grandparent–grandchild ties?

CONNECT Cite evidence that early family relationships affect middle-aged adults’ bonds with adult children, aging parents, and siblings.

APPLY Raylene and her brother Walter live in the same city as their aging mother, Elsie. When Elsie could no longer live independently, Raylene took primary responsibility for her care. What factors probably contributed to Raylene’s involvement in caregiving and Walter’s lesser role?

REFLECT Ask one of your parents for his or her view of how the parent–child relationship changed as you transitioned to new adult roles, such as college student, career-entry worker, married partner, or parent. Do you agree?

image24 Vocational Life

As we have seen, the midlife transition typically involves vocational adjustments. For Devin, it resulted in a move up the career ladder to a demanding administrative post as college dean. Trisha reoriented her career from a large to a small law firm, where she felt her efforts were appreciated. Recall from  Chapter 15  that after her oldest child left home, Anya earned a college degree and entered the work force for the first time. Jewel strengthened her commitment to an already successful business, while Elena changed careers. Finally, Tim reduced his career obligations as he prepared for retirement.

Work continues to be a salient aspect of identity and self-esteem in middle adulthood. More so than in earlier or later years, people attempt to increase the personal meaning and self-direction of their vocational lives. At the same time, certain aspects of job performance improve. Middle-aged employees have lower rates of absenteeism, turnover, and accidents. They are also more effective workplace citizens—more often helping colleagues and trying to improve group performance and less often complaining about trivial issues. And because of their greater knowledge and experience, their work productivity typically equals or exceeds that of younger workers (Ng & Feldman,  2008 ). Consequently, an older employee ought to be as valuable as a younger employee, and possibly more so.

The large tide of baby boomers currently moving through midlife and (as we will see in  Chapter 18 ) the desire of most to work longer than the previous generation means that the number of older workers will rise dramatically over the next few decades (Leonesio et al.,  2012 ). Yet a favorable transition from adult worker to older worker is hindered by negative stereotypes of aging—incorrect assumptions of limited learning capacity, slower decision making, and resistance to change and supervision (Posthuma & Campion,  2009 ). Furthermore, gender discrimination continues to restrict the career attainments of many women. Let’s take a close look at middle-aged work life.

Job Satisfaction

Job satisfaction has both psychological and economic significance. If people are dissatisfied at work, the consequences include absenteeism, turnover, grievances, and strikes, all of which are costly to employers.

Research shows that job satisfaction increases in midlife in diverse nations and at all occupational levels, from executives to hourly workers (see  Figure 16.6  on  page 554 ). The relationship is weaker for women than for men, probably because women’s reduced chances for advancement result in a sense of unfairness. It is also weaker for blue-collar than for white-collar workers, perhaps because blue-collar workers have less control over their own work schedules and activities (Avolio & Sosik,  1999 ). When different aspects of jobs are considered, intrinsic satisfaction—happiness with the work itself—shows a strong age-related gain. Extrinsic satisfaction—contentment with supervision, pay, and promotions—changes very little (Barnes-Farrell & Matthews,  2007 ).

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FIGURE 16.6 Age-related changes in job satisfaction.

In this study of more than 2,000 university employees at all levels, from secretary to university president, job satisfaction dropped slightly in early adulthood as people encountered some discouraging experiences (see  Chapter 14 ). In middle age, job satisfaction showed a steady rise.

(From W. A. Hochwarter et al., 2001, “A Note on the Nonlinearity of the Age–Job-Satisfaction Relationship,” Journal of Applied Social Psychology, 31, p. 1232. Copyright © 2001, John Wiley and Sons. Reproduced with permission of Wiley Inc.)

What explains the rise in job satisfaction during middle adulthood? An improved capacity to cope effectively with difficult situations and a broader time perspective probably contribute. “When I first started teaching, I complained about a lot of things,” remarked Devin. “From my current vantage point, I can tell a big problem from a trivial one.” Moving out of unrewarding work roles, as Trisha did, can also boost morale. Key characteristics that predict job well-being include involvement in decision making, reasonable workloads, and good physical working conditions. Older people may have greater access to jobs that are attractive in these ways. Furthermore, having fewer alternative positions into which they can move, older workers generally reduce their career aspirations (Barnes-Farrell & Matthews,  2007 ). As the perceived gap between actual and possible achievements narrows, job involvement—importance of one’s work to self-esteem—increases (Warr,  2001 ).

Although emotional engagement with work is usually seen as psychologically healthy, it can also result in  burnout —a condition in which long-term job stress leads to mental exhaustion, a sense of loss of personal control, and feelings of reduced accomplishment. Burnout occurs more often in the helping professions, including health care, human services, and teaching, which place high emotional demands on employees. Although people in interpersonally demanding jobs are as psychologically healthy as other people, sometimes a worker’s dedication exceeds his or her coping skills, especially in an unsupportive work environment (Schmidt, Neubach, & Heuer,  2007 ). Burnout is associated with excessive work assignments for available time and lack of encouragement and feedback from supervisors. It tends to occur more often in the United States than in Western Europe, perhaps because of Americans’ greater achievement orientation (Maslach, Schaufeli, & Leiter,  2001 ).

Burnout is a serious occupational hazard, linked to impaired attention and memory, severe depression, on-the-job injuries, physical illnesses, poor job performance, absenteeism, and turnover (Sandström et al.,  2005 ; Wang,  2005 ). To prevent burnout, employers can make sure workloads are reasonable, provide opportunities for workers to take time out from stressful situations, limit hours of stressful work, and offer social support. Interventions that enlist employees’ participation in designing higher-quality work environments show promise for increasing work engagement and effectiveness and reducing burnout (Leiter, Gascón, & Martínez-Jarreta,  2010 ). And provisions for working at home may respond to the needs of some people for a calmer, quieter work atmosphere.

Career Development

After several years as a parish nurse, Anya felt a need for additional training to do her job better. Trisha appreciated her firm’s generous support of workshop and course attendance, which helped her keep abreast of new legal developments. And as college dean, Devin took a summer seminar each year on management effectiveness. As these experiences reveal, career development is vital throughout work life.

Job Training.

Anya’s 35-year-old supervisor, Roy, was surprised when she asked for time off to upgrade her skills. “You’re in your fifties,” he replied. “What’re you going to do with so much new information at this point in your life?”

Roy’s insensitive, narrow-minded response, though usually unspoken, is all too common among managers—even some who are older themselves! Research suggests that training and on-the-job career counseling are less available to older workers. And when career development activities are offered, older employees may be less likely to volunteer for them (Barnes-Farrell & Matthews,  2007 ; Hedge, Borman, & Lammlein,  2006 ). What influences willingness to engage in job training and updating?

Personal characteristics are important: With age, growth needs give way somewhat to security needs. Consequently, learning and challenge may have less intrinsic value to many older workers. Perhaps for this reason, older employees depend more on co-worker and supervisor encouragement for vocational development. Yet as we have seen, they are less likely to have supportive supervisors. Furthermore, negative stereotypes of aging reduce older workers’ self-efficacy, or confidence that they can get better at their jobs (Maurer,  2001 ; Maurer, Wrenn, & Weiss,  2003 ). Self-efficacy is a powerful predictor of employees’ efforts to renew and expand career-relevant skills.

Workplace characteristics matter, too. An employee given work that requires new learning must pursue that learning to complete the assignment. Unfortunately, older workers sometimes receive more routine tasks than younger workers. Therefore, some of their reduced motivation to engage in career-relevant learning may be due to the type of assignments they receive. In companies with a more favorable age climate (view of older workers), mature employees participate frequently in further education and report greater self-efficacy and commitment to the organization (Bowen, Noack, & Staudinger,  2011 ).

Gender and Ethnicity: The Glass Ceiling.

In her thirties, Jewel became a company president by starting her own business. Having concluded that, as a woman, she had little chance of rising to a top executive position in a large corporation, she didn’t even try. Although women and ethnic minorities have gradually gained in access to managerial careers, they remain a long distance from gender and ethnic equality (Huffman,  2012 ). From career entry on, inequalities in promotion between men and women and between whites and blacks become more pronounced over time—findings still evident after education, work skills, and work productivity have been controlled (Barreto, Ryan, & Schmitt,  2009 ; Maume,  2004 ). Women who are promoted usually get stuck in mid-level positions. When the most prestigious high-level management jobs are considered, white men are overwhelmingly advantaged: They account for 70 percent of chief executive officers at large corporations and 93 percent at Fortune 500 companies (U.S. Census Bureau,  2012b ).

image26

Facebook executive Sheryl Sandberg is among a handful of women who have attained top positions in major corporations. In her best-selling book, Lean In, she urges women to be more assertive in demonstrating qualities linked to leadership at work.

Women and ethnic minorities face a  glass ceiling,  or invisible barrier to advancement up the corporate ladder. Why is this so? Management is an art and skill that must be taught. Yet women and ethnic minorities have less access to mentors, role models, and informal networks that serve as training routes (Baumgartner & Schneider,  2010 ). And stereotyped doubts about women’s career commitment and ability to become strong managers (especially women with children) also contribute, leading supervisors to underrate their competence and not to recommend them for formal management training programs (Hoobler, Lemmon, & Wayne,  2011 ). Furthermore, challenging, high-risk, high-visibility assignments that require leadership and open the door to advancement, such as startup ventures, international experience, and troubleshooting, are less often granted to both women and minorities.

Finally, women who demonstrate qualities linked to leadership and advancement—assertiveness, confidence, forcefulness, and ambition—encounter prejudice because they deviate from traditional gender roles, even though they more often combine these traits with a democratic, collaborative style of leading than do men (Cheung & Halpern,  2010 ; Eagly & Carli,  2007 ). To overcome this bias, women in line for top positions must demonstrate greater competence than their male counterparts. In an investigation of several hundred senior managers at a multinational financial services corporation, promoted female managers had earned higher performance ratings than promoted male managers (Lyness & Heilman,  2006 ). In contrast, no gender difference existed in performance of managers not selected for promotion.

Like Jewel, many women have dealt with the glass ceiling by going around it, leaving the corporate environment and going into business for themselves. Today, more than half of all startup businesses in the United States are owned and operated by women. The large majority are successful entrepreneurs and leaders, meeting or exceeding their expansion and earnings goals (Ahuja,  2005 ; U.S. Census Bureau,  2012b ). But when women and ethnic minorities leave the corporate world to further their careers, companies not only lose valuable talent but also fail to address the leadership needs of an increasingly diverse work force.

Career Change at Midlife

Although most people remain in the same vocation through middle age, career change does occur, as with Elena’s shift from journalism to teaching and creative writing. Recall that circumstances at home and at work motivated Elena’s decision to pursue a new vocation. Like other career changers, she wanted a more satisfying life—a goal she attained by ending an unhappy marriage and initiating a long-awaited vocational move at the same time.

As noted earlier, midlife career changes are seldom radical; they typically involve leaving one line of work for a related one. Elena sought a more stimulating, involving job. But other people move in the reverse direction—to careers that are more relaxing, free of painful decisions, and less demanding (Juntunen, Wegner, & Matthews,  2002 ). The decision to change is often difficult. The individual must weigh years invested in one set of skills, current income, and job security against present frustrations and hoped-for gains.

image27

After many years as a professor of ancient Greek philosophy, Abe Schoener found himself at a dead end in his career. In his mid-forties, he decided to transform his passion for winemaking into a new vocation as a vintner—a radical shift that prompted the breakup of his marriage but ultimately led to a more satisfying life.

An extreme career shift, by contrast, usually signals a personal crisis (Young & Rodgers,  1997 ). In a study of professionals who abandoned their well-paid, prestigious positions for routine, poorly paid, semiskilled work, nonwork problems contributed to radical change. An eminent 55-year-old TV producer became a school bus driver, a New York banker a waiter in a ski resort (Sarason,  1977 ). Each was responding to feelings of personal meaninglessness—escaping from family conflict, difficult relationships with colleagues, and work that had become unsatisfying to a less burdensome life.

Among blue-collar workers—those in such occupations as construction, manufacturing, mining, maintenance, or foodservice work—midlife career shifts are seldom freely chosen. In one investigation, researchers followed a large sample of blue-collar men in their fifties over a seven-year period; all were employed by Alcoa, the world’s largest producer of aluminum. One-third had highly physically taxing jobs. Of the small minority who transitioned to less physically demanding work, an injury usually preceded the change (Modrek & Cullen,  2012 ). Transitioners appeared to change jobs to stay in the workforce, rather than being forced to retire early, at less than full pension benefits, because of their disability.

Yet opportunities to shift to less physically demanding work are limited, particularly in the late-2000s recession aftermath. A strong predictor of middle-aged workers’ eligibility for such jobs for is education—at least a high school diploma (Blau & Goldstein,  2007 ). Less educated workers with a physical disability face greatly reduced chances of remaining in the labor force.

Unemployment

As companies downsize, eliminating jobs, the majority of people affected are middle-aged and older. Although unemployment is difficult at any time, middle-aged adults show a sharper decline in physical and mental health than their younger counterparts. Those who perceive a company’s layoff process as unfair and inconsiderate—for example, giving them little time to prepare—often experience the event as highly traumatic (Breslin & Mustard,  2003 ; McKee-Ryan et al.,  2009 ). Older workers affected by layoffs remain jobless longer, suffering substantial income loss. In addition, people over age 40 who must reestablish occupational security find themselves “off-time” in terms of the social clock. Consequently, job loss can disrupt major tasks of midlife, including generativity and reappraisal of life goals and accomplishments. Finally, having been more involved in and committed to an occupation, the older unemployed worker has also lost something of greater value.

People who lose their jobs in midlife, whether executives or blue-collar workers, seldom duplicate the status and pay of their previous positions. As they search, they encounter age discrimination and find that they are over-qualified for many openings. Those also facing financial difficulties are at risk for deepening depression and physical health declines over time (Gallo et al.,  2006 ; McKee-Ryan,  2011 ). Counseling that focuses on financial planning, reducing feelings of humiliation due to the stigma of unemployment, and encouraging personal flexibility can help people implement effective problem-centered coping strategies in their search for alternative work roles.

Planning for Retirement

One evening, Devin and Trisha met Anya and her husband, George, for dinner. Halfway through the meal, Devin inquired, “George, tell us what you and Anya are going to do about retirement. Are you planning to close down your business or work part-time? Do you think you’ll stay here or move out of town?”

Three or four generations ago, the two couples would not have had this conversation. In 1900, about 70 percent of American men age 65 and over were in the labor force. By 1970, however, the figure had dropped to 27 percent, and in the early twenty-first century it declined to 16 percent (U.S. Census Bureau,  2012b ). Because of government-sponsored retirement benefits (begun in the United States in 1935), retirement is no longer a privilege reserved for the wealthy. The federal government pays Social Security to the majority of the aged, and others are covered by employer-based private pension plans.

As the trend just noted suggests, the average age of retirement has declined over the past several decades. Currently, it is age 63 in the United States and hovers between 60 and 63 in other Western nations (U.S. Census Bureau,  2012b ). The recent recession led to an increase in the number of Americans at risk for being unable to sustain their preretirement standard of living after leaving the workforce. Consequently, a survey of a large, nationally representative sample of baby boomers revealed that the majority expect to delay retirement (Jones,  2012 ). But current estimates indicate that most will need to work just a few extra years to be financially ready to retire (Munnell et al.,  2012 ). For the healthy, active, long-lived baby-boom generation, up to one-fourth of their lives may lie ahead after they leave their jobs.

Applying What We Know : Ingredients of Effective retirement Planning

Issue Description
Finances Ideally, financial planning for retirement should start with the first paycheck; at a minimum, it should begin 10 to 15 years before retirement.
Fitness Starting a fitness program in middle age is important because good health is crucial for well-being in retirement.
Role adjustment Retirement is harder for people who strongly identify with their work role. Preparing for a radical role adjustment reduces stress.
Where to live The pros and cons of moving should be considered carefully because where one lives affects access to health care, friends, family, recreation, entertainment, and part-time employment.
Leisure and volunteer activities A retiree typically gains an additional 50 hours per week of free time. Careful planning of what to do with that time has a major impact on psychological well-being.
Health insurance Finding out about government-sponsored health insurance options helps protect quality of life after retirement.
Legal affairs The preretirement period is an excellent time to finalize a will and begin estate planning.

Retirement is a lengthy, complex process that begins as soon as the middle-aged person first thinks about it (Kim & Moen,  2002b ). Planning is important because retirement leads to a loss of two important work-related rewards—income and status—and to a change in many other aspects of life. Like other life transitions, retirement can be stressful.

Nearly half of middle-aged people engage in no concrete retirement planning, yet research consistently shows that clarifying goals for the future and acquiring financial-planning knowledge result in better retirement savings, adjustment, and satisfaction (Hershey et al.,  2007 ; Jacobs-Lawson, Hershey, & Neukam,  2004 ).

LOOK AND LISTEN

Contact the human resources division of a company or institution in your community, and inquire about the retirement planning services it offers. How comprehensive are those services, and what percentage of its recent retirees made use of them?•

Applying What We Know above lists the variety of issues addressed in a typical retirement preparation program. Financial planning is especially vital in the United States where (unlike Western European nations) the federal government does not offer a pension system that guarantees an adequate standard of living (see  page 68  in  Chapter 2 ). Hence, U.S. retirees’ income typically drops by 50 percent. But although more people engage in financial planning than in other forms of preparation, even those who attend financial education programs often fail to look closely at their financial well-being and to make wise decisions (Keller & Lusardi,  2012 ). Many could benefit from an expert’s financial analysis and counsel.

Retirement leads to ways of spending time that are largely guided by one’s interests rather than one’s obligations. Individuals who have not thought carefully about how to fill this time may find their sense of purpose in life seriously threatened. Research reveals that planning for an active life has an even greater impact on happiness after retirement than financial planning. Participation in activities promotes many factors essential for psychological well-being, including a structured time schedule, social contact, and self-esteem (Schlossberg,  2004 ). Carefully considering whether or not to relocate at retirement is related to an active life, since it affects access to health care, friends, family, recreation, entertainment, and part-time work.

Devin retired at age 62, George at age 66. Though several years younger, Trisha and Anya—like many married women—coordinated their retirements with those of their husbands. In contrast, Jewel—in good health but without an intimate partner to share her life—kept her consulting business going until age 75. Tim took early retirement and moved to be near Elena, where he devoted himself to public service—tutoring second graders in a public school, transporting inner-city children to museums, and coaching after-school and weekend youth sports. For Tim, retirement offered a new opportunity to give generously to his community.

Unfortunately, less well-educated people with lower lifetime earnings are least likely to attend retirement preparation programs—yet they stand to benefit the most. And compared with men, women do less planning for retirement, instead relying on their husband’s preparations. This gender gap seems to be narrowing, however, as women increasingly contribute to family income (Adams & Rau,  2011 ). Employers must take extra steps to encourage lower-paid workers and women to participate in planning activities. In addition, enhancing retirement adjustment among the economically disadvantaged depends on access to better vocational training, jobs, and health care at early ages. Clearly, a lifetime of opportunities and experiences affects the transition to retirement. In  Chapter 18 , we will consider the decision to retire and retirement adjustment in greater detail.

ASK YOURSELF

REVIEW What factors contribute to the rise in job satisfaction with age?

CONNECT Supervisors sometimes assign the more routine tasks to older workers, believing that they can no longer handle complex assignments. Cite evidence from this and the previous chapter indicating that this assumption is incorrect.

APPLY An executive wonders how his large corporation can foster advancement of women and ethnic minorities to upper management positions. What strategies would you recommend?

image28 SUMMARY

Erikson’s Theory: Generativity versus Stagnation ( p. 532 )

According to Erikson, how does personality change in middle age?

· ● Generativity expands as middle-aged adults face Erikson’s psychological conflict of generativity versus stagnation. Personal desires and cultural demands jointly shape adults’ generative activities.

· ● Highly generative people, who contribute to society through parenthood, other family relationships, the workplace, and volunteer endeavors, appear especially well-adjusted. Stagnation occurs when people become self-centered and self-indulgent in midlife.

Other Theories of Psychosocial Development in Midlife ( p. 535 )

· Describe Levinson’s and Vaillant’s views of psychosocial development in middle adulthood, and discuss similarities and differences between men and women.

· ● According to Levinson, middle-aged adults confront four developmental tasks, each requiring them to reconcile two opposing tendencies within the self: young–old, destruction–creation, masculinity–femininity, and engagement–separateness.

· ● Middle-aged men show greater acceptance of “feminine” traits of nurturance and caring, while women are more open to “masculine” characteristics of autonomy and assertiveness. Men and successful career-oriented women may reduce their concern with ambition and achievement, but women who have devoted themselves to child rearing or an unfulfilling job often seek rewarding work or community engagement.

· ● Vaillant found that adults in their late forties and fifties become guardians of their culture, seeking to “pass the torch” to later generations.

Does the term midlife crisis reflect most people’s experience of middle adulthood, and is middle adulthood accurately characterized as a stage?

· ● Most people respond to midlife with changes that are better described as “turning points” than as a crisis. Only a minority experience a midlife crisis characterized by intense self-doubt and stress that lead to drastic life alterations.

· ● Some midlife changes are adaptations to life events that are less age-graded than in the past. Most middle-aged adults also report troubling moments that prompt new understandings and goals, but debate persists over whether these psychosocial changes are stagelike.

Stability and Change in Self-Concept and Personality ( p. 538 )

· Describe changes in self-concept, personality, and gender identity in middle adulthood.

· ● Middle-aged individuals maintain self-esteem and stay motivated by revising their possible selves, which become fewer in number as well as more modest and concrete as people adjust their hopes and fears to their life circumstances.

· ● Midlife typically brings enhanced psychological well-being, through greater self-acceptance, autonomy, and environmental mastery. Factors contributing to well-being, however, vary widely among cohorts and cultures.

· ● Daily stressors plateau in early to mid-adulthood, and then decline as work and family responsibilities ease. Midlife gains in emotional stability and confidence in handling life’s problems lead to increased effectiveness in coping with stressors.

· ● Both men and women become more androgynous in middle adulthood. Biological explanations, such as parental imperative theory, are controversial. A combination of social roles and life conditions is more likely responsible. image29

· Discuss stability and change in the “big five” personality traits in adulthood.

· ● Among the “big five” personality traits, agreeableness and conscientiousness increase into middle age, while neuroticism declines, and extroversion and openness to experience do not change or decrease slightly. Individual differences are large and highly stable: Although adults change in overall organization and integration of personality, they do so on a foundation of basic, enduring dispositions.

Relationships at Midlife ( p. 543 )

· Describe the middle adulthood phase of the family life cycle.

· ● “Launching children and moving on” is the midlife phase of the family life cycle. Adults must adapt to many entries and exits of family members as their children launch–return–relaunch, marry, and produce grandchildren, and as their own parents age and die.

· ● When divorce occurs, middle-aged adults seem to adapt more easily than younger people. For women, midlife marital breakup often severely reduces standard of living, contributing to the feminization of poverty.

· ● Most middle-aged parents adjust well to launching adult children, especially if positive parent–child relationships are sustained, but adult children who are “off-time” in development can prompt parental strain. As children marry, middle-aged parents, especially mothers, often become kinkeepers.

· ● Grandparents’ contact and closeness with grandchildren depend on proximity, number of grandchild sets, sex of grandparent and grandchild, and in-law relationships. In low-income families and in some ethnic groups, grandparents provide essential financial and child-care assistance. When serious family problems exist, grandparents may become primary caregivers in skipped-generation families. image30

· ● Middle-aged adults reassess their relationships with aging parents, often becoming more appreciative. Mother–daughter relationships tend to be closer than other parent–child ties. The more positive the history of the parent–child tie and the greater the need for assistance, the more help exchanged.

· ● Middle-aged adults, often caught between caring for aging parents, assisting young-adult children and grandchildren, and meeting work and community responsibilities, are called the sandwich generation. The burden of caring for ill or frail parents falls most heavily on adult daughters, though the sex difference declines in later middle age.

· ● Parental caregiving has emotional and health consequences, especially in cultures and subcultures where adult children feel a particularly strong obligation to provide care. Social support is highly effective in reducing caregiver stress and helping adult children derive benefits from caregiving.

Describe midlife sibling relationships and friendships.

· ● Sibling contact and support decline from early to middle adulthood, probably because of the demands of diverse roles. But many middle-aged siblings feel closer, often in response to major life events. Sister–sister ties are typically closest in industrialized nations. In nonindustrialized societies, strong brother–sister attachments may be basic to family functioning.

· ● In midlife, friendships become fewer, more selective, and more deeply valued. Men continue to be less expressive with their friends than women, who have more close friendships. Viewing a spouse as a best friend can contribute greatly to marital happiness.

Vocational Life ( p. 553 )

· Discuss job satisfaction and career development in middle adulthood, with special attention to sex differences and experiences of ethnic minorities.

· ● Vocational readjustments are common as middle-aged people seek to increase the personal meaning and self-direction of their work lives. Certain aspects of job performance improve. Job satisfaction increases at all occupational levels, more so for men than for women.

· ● Burnout is a serious occupational hazard, especially for those in helping professions. It can be prevented by ensuring reasonable workloads, limiting hours of stressful work, providing workers with social support, and enlisting employees’ participation in designing higher-quality work environments.

· ● Both personal and workplace characteristics influence the extent to which older workers engage in career development. In companies with a more favorable age climate, mature employees report greater self-efficacy and commitment to the organization.

· ● Women and ethnic minorities face a glass ceiling because of limited access to management training and prejudice against women who demonstrate strong leadership qualities. Many women further their careers by leaving the corporate world, often to start their own businesses.

Discuss career change and unemployment in middle adulthood.

· ● Midlife career change typically involves leaving one line of work for a related one. Radical career change often signals a personal crisis. Among blue-collar workers, midlife career shifts are seldom freely chosen. image31

· ● Unemployment is especially difficult for middle-aged adults, who constitute the majority of workers affected by corporate downsizing and layoffs. Counseling can help them find alternative, gratifying work roles, but these rarely match their previous status and pay.

Discuss the importance of planning for retirement.

· ● Retirement brings major life changes, including loss of income and status and an increase in free time. Besides financial planning, planning for an active life is vital, with a strong impact on happiness after retirement. Low-paid workers and women need extra encouragement to participate in retirement planning.

Important Terms and Concepts

“big five” personality traits ( p. 542 )

burnout ( p. 554 )

feminization of poverty ( p. 544 )

generativity versus stagnation ( p. 532 )

glass ceiling ( p. 555 )

kinkeeper ( p. 545 )

midlife crisis ( p. 536 )

parental imperative theory ( p. 540 )

possible selves ( p. 538 )

sandwich generation ( p. 549 )

skipped-generation family ( p. 548 )

image32 milestones Development in Middle Adulthood

image33

40–50 years

· PHYSICAL

· ■ Accommodative ability of the lens of the eye, ability to see in dim light, and color discrimination decline; sensitivity to glare increases. ( 502 – 503 )

· ■ Hearing loss at high frequencies occurs. ( 503 )

· ■ Hair grays and thins. ( 502 )

· ■ Lines on the face become more pronounced; skin loses elasticity and begins to sag. ( 503 )

· ■ Weight gain continues, accompanied by a rise in fatty deposits in the torso, while fat beneath the skin declines. ( 504 )

· ■ Loss of lean body mass (muscle and bone) occurs. ( 504 )

· ■ In women, production of estrogen drops, leading to shortening and irregularity of the menstrual cycle. ( 504 ) image34

· ■ In men, quantity of semen and sperm declines. ( 507 )

· ■ Intensity of sexual response declines, but frequency of sexual activity drops only slightly. ( 509 )

· ■ Rates of cancer and cardiovascular disease increase. ( 509 – 513 )

COGNITIVE

· ■ Consciousness of aging increases. (502, 535)

· ■ Crystallized intelligence increases; fluid intelligence declines. ( 518 – 519 )

· ■ Speed of processing declines, but adults can compensate through experience and practice. ( 520 – 521 ) image35

· ■ Ability to attend selectively and to adapt attention—switching from one task to another—declines, but adults can compensate through experience and practice. ( 521 )

· ■ Amount of information retained in working memory declines, in part because of reduced use of memory strategies. ( 522 )

· ■ Retrieving information from long-term memory becomes more difficult. ( 522 )

· ■ General factual knowledge, procedural knowledge, knowledge related to one’s occupation, and metacognitive knowledge remain unchanged or may increase. ( 522 – 523 ) image36

· ■ Practical problem solving and expertise increase. ( 524 )

· ■ Creativity may become more deliberately thoughtful, emphasize integrating ideas, and shift from self-expression to more altruistic goals. ( 524 – 525 ) image37

· ■ If occupation offers challenge and autonomy, may show gains in cognitive flexibility. ( 525 – 526 )

EMOTIONAL/SOCIAL

· ■ Generativity increases. ( 532 – 533 )

· ■ Focus shifts toward personally meaningful living. ( 535 ) image38

· ■ Possible selves become fewer in number and more modest and concrete. ( 538 )

· ■ Self-acceptance, autonomy, and environmental mastery increase. ( 538 – 539 )

· ■ Strategies for coping with stressors become more effective. ( 539 )

· ■ Gender identity becomes more androgynous;

“masculine” traits increase in women, “feminine” traits in men. (535, 540–542)

· ■ Agreeableness and conscientiousness increase, while neuroticism declines. ( 542 )

· ■ May launch children. ( 544 – 545 )

· ■ May become a kinkeeper, especially if a mother. ( 545 )

· ■ May become a parent-in-law and a grandparent. ( 545 – 547 )

· ■ Becomes more appreciative of parents’ strengths and generosity; quality of relationships with parents increase. ( 547 )

· ■ May care for a parent with a disability or chronic illness. ( 549 – 551 )

· ■ Siblings may feel closer. ( 552 ) image39

· ■ Number of friends generally declines. ( 552 )

· ■ Intrinsic job satisfaction—happiness with one’s work—typically increases. ( 553 – 554 ) image40

50–65 years

PHYSICAL

· ■ Lens of the eye loses its capacity to adjust to objects at varying distances entirely. ( 502 )

· ■ Hearing loss gradually extends to all frequencies but remains greatest for high frequencies. ( 503 )

· ■ Skin continues to wrinkle and sag, “age spots” increase, and blood vessels in the skin become more visible. ( 503 )

· ■ In women, menopause occurs; as estrogen declines further, genitals are less easily stimulated, and the vagina lubricates more slowly during arousal. ( 504 )

· ■ In men, inability to attain an erection when desired becomes more common. ( 507 )

· ■ Loss of bone mass continues; rates of osteoporosis rise. (504, 512–513)

· ■ Collapse of disks in the spinal column causes height to drop by as much as 1 inch. ( 504 )

· ■ Rates of cancer and cardiovascular disease continue to increase. ( 509 – 513 ) image41

COGNITIVE

· ■ Cognitive changes previously listed continue. image42

EMOTIONAL/SOCIAL

· ■ Emotional and social changes previously listed continue. image43

· ■ Parent-to-child help-giving declines, and child-to-parent support and practical assistance increase. ( 548 – 549 ) image44

· ■ May retire. ( 556 – 557 )

Note: Numbers in parentheses indicate the page or pages on which each milestone is discussed.

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Help in Cyberrat homework

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Decoding the Ethics Code, Ch. 6

July 1, 2025/in Psychology Questions /by Besttutor

CHAPTER 6

Standards on

Human Relations

3. Human Relations

3.01 Unfair Discrimination

In their work-related activities, psychologists do not engage in unfair discrimination based on age,

gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability,

socioeconomic status, or any basis proscribed by law.

Psychologists respect the dignity and worth of all people and appropriately consider

the relevance of personal characteristics based on factors such as age, gender,

gender identity, race, ethnicity, culture, national origin, religion, sexual orientation,

disability, or socioeconomic status (Principle E: Respect for People’s Rights and

Dignity). Much of the work of psychologists entails making valid discriminating

judgments that best serve the people and organizations they work with and fulfilling

their ethical obligations as teachers, researchers, organizational consultants, and

practitioners. Standard 3.01 of the APA Ethics Code (APA, 2002b) does not prohibit

such discriminations.

􀀵 The graduate psychology faculty of a university used differences in standardized test

scores, undergraduate grades, and professionally related experience as selection criteria

for program admission.

􀀵 A research psychologist sampled individuals from specific age, gender, and cultural

groups to test a specific hypothesis relevant to these groups.

􀀵 An organizational psychologist working for a software company designed assessments

for employee screening and promotion to distinguish individuals with the

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

92——PART II ENFORCEABLE STANDARDS

Standard 3.01 does not require psychologists offering therapeutic assistance to

accept as clients/patients all individuals who request mental health services. Discerning

and prudent psychologists know the limitations of their competence and accept to

treat only those whom they can reasonably expect to help based on their education,

training, and experience (Striefel, 2007). Psychologists may also refuse to accept

clients/patients on the basis of individuals’ lack of commitment to the therapeutic

process, problems they have that fall outside the therapists’ area of competence, or their

perceived inability or unwillingness to pay for services (Knapp & VandeCreek, 2003).

Psychologists must, however, exercise reasonable judgment and precautions to

ensure that their work does not reflect personal or organizational biases or prejudices

that can lead to injustice (Principle D: Justice). For example, the American

Psychological Association’s (APA’s) Resolution on Religious, Religion-Based, and/or

Religion-Derived Prejudice (APA, 2007d) condemns prejudice and discrimination

against individuals or groups based on their religious or spiritual beliefs, practices,

adherence, or background.

Standard 3.01 prohibits psychologists from making unfair discriminations based

on the factors listed in the standard.

requisite information technology skills to perform tasks essential to the positions from

individuals not possessing these skills.

􀀵 A school psychologist considers factors such as age, English language proficiency, and

hearing or vision impairment when making educational placement recommendations.

􀀵 A family bereavement counselor working in an elder care unit of a hospital regularly

considered the extent to which factors associated with the families’ culture or religious

values should be considered in the treatment plan.

􀀵 A psychologist conducting couples therapy with gay partners worked with clients to

explore the potential effects of homophobia, relational ambiguity, and family support

on their relationship (Green & Mitchell, 2002).

􀀴 The director of a graduate program in psychology rejected a candidate for program

admission because the candidate indicated that he was a Muslim.

􀀴 A consulting psychologist agreed to a company’s request to develop pre-employment

procedures that would screen out applicants from Spanish-speaking cultures based on

the company’s presumption that the majority of such candidates would be undocumented

residents.

􀀴 A psychologist working in a Medicaid clinic decided not to include a cognitive component

in a behavioral treatment based solely on the psychologist’s belief that lowerincome

patients were incapable of responding to “talk therapies.”

􀀴 One partner of a gay couple who recently entered couple counseling called their psychologist

when he learned that he tested positive for the HIV virus. Although when

working with heterosexual couples the psychologist strongly encouraged clients to

inform their partners if they had a sexually transmitted disease, she did not believe such

an approach was necessary in this situation based on her erroneous assumption that

all gay men engaged in reckless and risky sexual behavior (see Palma & Iannelli, 2002).

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Chapter 6 Standards on Human Relations——93

Discrimination Proscribed by Law

Standard 3.01 prohibits psychologists from discriminating among individuals on

any basis proscribed by law. For example, industrial–organizational psychologists

need to be aware of nondiscrimination laws relevant to race, religion, and disability

that apply to companies for which they work (e.g., ADA, www.ada.gov; Title VII of

the Civil Rights Act of 1964, www.eeoc.gov/laws/statutes/titlevii.cfm, archive.eeoc

.gov/types/religion.html; Workforce Investment Act of 1998, www.doleta.gov/

usworkforce/wia/wialaw.txt). Psychologists conducting personnel performance

evaluations should avoid selecting tests developed to assess psychopathology (see

Karraker v. Rent-a-Center, 2005). In addition, under ADA (1990), disability-relevant

questions can only be asked of prospective employees after the employer has made

a conditional offer. In some instances, ADA laws for small businesses also apply to

psychologists in private practice, such as wheelchair accessibility. In addition,

HIPAA prohibits covered entities from discriminating against an individual for filing

a complaint, participating in a compliance review or hearing, or opposing an act or

practice that is unlawful under the regulation (45 CFR 164.530[g]).

3.02 Sexual Harassment

Psychologists do not engage in sexual harassment. Sexual harassment is sexual solicitation,

physical advances, or verbal or nonverbal conduct that is sexual in nature, that occurs in connection

with the psychologist’s activities or role as a psychologist, and that either (1) is unwelcome,

is offensive, or creates a hostile workplace or educational environment, and the psychologist

knows or is told this; or (2) is sufficiently severe or intense to be abusive to a reasonable person

in the context. Sexual harassment can consist of a single intense or severe act or of multiple

persistent or pervasive acts. (See also Standard 1.08, Unfair Discrimination Against Complainants

and Respondents.)

It is always wise for psychologists to be familiar with and comply with applicable

laws and institutional policies regarding sexual harassment. Laws on sexual

harassment vary across jurisdictions, are often complex, and change over time.

Standard 3.02 provides a clear definition of behaviors that are prohibited and considered

sexual harassment under the Ethics Code. When this definition establishes

a higher standard of conduct than required by law, psychologists must comply

with Standard 3.02.

According to Standard 3.02, sexual harassment can be verbal or nonverbal

solicitation, advances, or sexual conduct that occurs in connection with the psychologist’s

activities or role as a psychologist. The wording of the definition was

carefully crafted to prohibit sexual harassment without encouraging complaints

against psychologists whose poor judgments or behaviors do not rise to the level of

harassment. Thus, to meet the standard’s threshold for sexual harassment, behaviors

have to be either so severe or intense that a reasonable person would deem

them abusive in that context, or, regardless of intensity, the psychologist was aware

or had been told that the behaviors are unwelcome, offensive, or creating a hostile

workplace or educational environment.

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94——PART II ENFORCEABLE STANDARDS

For example, a senior faculty member who places an arm around a student’s

shoulder during a discussion or who tells an off-color sexual joke that offends a

number of junior faculty may not be in violation of this standard if such behavior

is uncharacteristic of the faculty member’s usual conduct, if a reasonable

person might interpret the behavior as inoffensive, and if there is reason to

assume the psychologist neither is aware of nor has been told the behavior is

offensive.

A hostile workplace or educational environment is one in which the sexual

language or behaviors of the psychologist impairs the ability of those who are the

target of the sexual harassment to conduct their work or participate in classroom

and educational experiences. The actions of the senior faculty member described

above might be considered sexual harassment if the psychologist’s behaviors

reflected a consistent pattern of sexual conduct during class or office hours, if

such behaviors had led students to withdraw from the psychologist’s class, or if

students or other faculty had repeatedly told the psychologist about the discomfort

produced.

􀀴 A senior psychologist at a test company sexually fondled a junior colleague during an

office party.

􀀴 During clinical supervision, a trainee had an emotional discussion with her female

supervisor about how her own experiences recognizing her lesbian sexual orientation

during adolescence were helping her counsel the gay and lesbian youths

she was working with. At the end of the session, the supervisor kissed the trainee

on the lips.

According to this standard, sexual harassment can also consist of a single intense

or severe act that would be considered abusive to a reasonable person.

A violation of this standard applies to all psychologists irrespective of the status,

sex, or sexual orientation of the psychologist or individual harassed.

3.03 Other Harassment

Psychologists do not knowingly engage in behavior that is harassing or demeaning to persons

with whom they interact in their work based on factors such as those persons’ age, gender, gender

identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language,

or socioeconomic status.

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Chapter 6 Standards on Human Relations——95

According to Principle E: Respect for People’s Rights and Dignity, psychologists

should eliminate from their work the effect of bias and prejudice based on factors

such as age, gender, gender identity, race, ethnicity, national origin, religion, sexual

orientation, disability, language, and socioeconomic status. Standard 3.03 prohibits

behaviors that draw on these categories to harass or demean individuals with

whom psychologists work, such as colleagues, students, research participants, or

employees. Behaviors in violation of this standard include ethnic slurs and negative

generalizations based on gender, sexual orientation, disability, or socioeconomic

status whose intention or outcome is lowering status or reputation.

The term knowingly reflects the fact that evolving societal sensitivity to language

and behaviors demeaning to different groups may result in psychologists unknowingly

acting in a pejorative manner. The term knowingly also reflects awareness that

interpretations of behaviors that are harassing or demeaning can often be subjective.

Thus, a violation of this standard rests on an objective evaluation that a psychologist

would have or should have been aware that his or her behavior would be

perceived as harassing or demeaning.

This standard does not prohibit psychologists from critical comments about

the work of students, colleagues, or others based on legitimate criteria. For

example, professors can inform, and often have a duty to inform, students that

their writing or clinical skills are below program standards or indicate when a

student’s classroom comment is incorrect or inappropriate. It is the responsibility

of employers or chairs of academic departments to critically review, report on,

and discuss both positive and negative evaluations of employees or faculty.

Similarly, the standard does not prohibit psychologists conducting assessment or

therapy from applying valid diagnostic classifications that a client/patient may

find offensive.

3.04 Avoiding Harm

Psychologists take reasonable steps to avoid harming their clients/patients, students, supervisees,

research participants, organizational clients, and others with whom they work, and to minimize

harm where it is foreseeable and unavoidable.

As articulated in Principle A: Beneficence and Nonmaleficence, psychologists

seek to safeguard the welfare of those with whom they work and avoid or minimize

harm when conflicts occur among professional obligations. In the rightly practiced

profession and science of psychology, harm is not always unethical or avoidable.

Legitimate activities that may lead to harm include (a) giving low grades to students

who perform poorly on exams; (b) providing a valid diagnosis that prevents a

client/patient from receiving disability insurance; (c) conducting personnel reviews

that lead to an individual’s termination of employment; (d) conducting a custody

evaluation in a case in which the judge determines one of the parents must relinquish

custodial rights; or (e) disclosing confidential information to protect the

physical welfare of a third party.

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96——PART II ENFORCEABLE STANDARDS

Steps for Avoiding Harm

Recognizing that such harms are not always avoidable or inappropriate,

Standard 3.04 requires psychologists to take reasonable steps to avoid harming

those with whom they interact in their professional and scientific roles and to

minimize harm where it is foreseeable and unavoidable.

These steps often include complying with other standards in the Ethics Code,

such as the following:

􀀵 Parents of a fourth-grade student wanted their child placed in a special education

class. After administering a complete battery of tests, the school psychologist’s

report indicated that the child’s responses did not meet established definitions for

learning disabilities and therefore did not meet the district’s criteria for such

placement.

􀀵 A forensic psychologist was asked to evaluate the mental status of a criminal

defendant who was asserting volitional insanity as a defense against liability in

his trial for manslaughter. The psychologist conducted a thorough evaluation

based on definitions of volitional insanity and irresistible impulse established by

the profession of psychology and by law. While the psychologist’s report noted

that the inmate had some problems with impulse control and emotional instability,

it also noted that these deficiencies did not meet the legal definition of volitional

that would bar prosecution (see also Hot Topic “Human Rights and

Psychologists’ Involvement in Assessments Related to Death Penalty Cases” in

Chapter 4).

􀀴 A psychologist conducted therapy over the Internet for clients/patients in a rural area

120 miles from her office. The psychologist had not developed a plan with each client/

patient for handling mental health crises. During a live video Internet session, a client

who had been struggling with bouts of depression showed the psychologist his gun

and said he was going outside to “blow his head off.” The psychologist did not have

the contact information of any local hospital, relative, or friend to send prompt emergency

assistance.

􀀴 A psychologist with prescription privileges prescribed a Food and Drug Administration

(FDA)-approved neuroenhancer to help a young adult patient suffering from performance

anxiety associated with his responsibilities as quarterback for his college varsity

football team. The psychologist failed to discuss the importance of gradual reduction in

dosage, and she was dismayed to learn that her patient had been hospitalized after he

abruptly discontinued the medication when the football season ended (APA, 2011a;

McCrickerd, 2010; I. Singh & Kelleher, 2010).

􀀴 Consistent with Standard 10.10a, Terminating Treatment, a psychologist treating a

client/patient with a diagnosis of borderline disorder terminated therapy when she

realized the client/patient had formed an iatrogenic attachment to her that was clearly

interfering with any benefits that could be derived from the treatment. However, her

failure to provide appropriate pretermination counseling and referrals contributed to

the client’s/patient’s emergency hospitalization for suicidal risk (Standard 10.10c,

Terminating Treatment).

HMO

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Chapter 6 Standards on Human Relations——97

Is Use of Aversion Therapies Unethical?

Aversion therapy involves the repeated association of a maladaptive behavior or

cognition with an aversive stimulus (e.g., electric shock, unpleasant images, nausea)

to eliminate pleasant associations or introduce negative associations with the undesirable

behavior. Aversion therapies have proved promising in treatments of drug

cravings, alcoholism, and pica (Bordnick, Elkins, Orr, Walters, & Thyer, 2004;

Ferreri, Tamm, & Wier, 2006; Thurber, 1985) and have been used with questionable

effectiveness for pedophilia (Hall & Hall, 2007). It is beyond the purview of this

volume to review literature evaluating the clinical efficacy of aversion therapies for

different disorders. However, even with evidence of clinical efficacy, aversion therapies

have and will continue to require ethical deliberation because they purposely

subject clients/patients to physical and emotional discomfort and distress. In so

doing, they raise the fundamental moral issue of balancing doing good against

doing no harm (Principle A: Beneficence and Nonmaleficence).

Psychologists should consider the following questions before engaging in aversion

therapy:

Have all empirically and clinically validated alternative therapeutic approaches

been attempted?

Is there empirical evidence that the aversive therapeutic approach has demonstrated

effectiveness with individuals who are similar to the client/patient in

mental health disorder, age, physical health, and other relevant factors?

(Standard 2.04, Bases for Scientific and Professional Judgments)

􀀵 Clarifying course requirements and establishing a timely and specific process for providing

feedback to students (Standard 7.06, Assessing Student and Supervisee Performance)

􀀵 Selecting and using valid and reliable assessment techniques appropriate to the nature

of the problem and characteristics of the testee to avoid misdiagnosis and inappropriate

services (Standards 9.01, Bases for Assessments, and 9.02, Use of Assessments)

􀀵 When appropriate, providing information beforehand to employees and others who

may be directly affected by a psychologist’s services to an organization (Standard 3.11,

Psychological Services Delivered To or Through Organizations)

􀀵 Acquiring adequate knowledge of relevant judicial or administrative rules prior to

performing forensic roles to avoid violating the legal rights of individuals involved in

litigation (Standard 2.01f, Boundaries of Competence)

􀀵 Taking steps to minimize harm when, during debriefing, a psychologist becomes aware

of participant distress created by the research procedure (Standard 8.08c, Debriefing)

􀀵 Becoming familiar with local social service, medical, and legal resources for clients/

patients and third parties who will be affected if a psychologist is ethically or legally

compelled to report child abuse, suicide risk, elder abuse, or intent to do physical harm

to another individual (Standard 4.05b, Disclosures)

􀀵 Monitoring patient’s physiological status when prescribing medications (with legal

prescribing authority), particularly when there is a physical condition that might complicate

the response to psychotropic medication or predispose a patient to experience

an adverse reaction (APA, 2011a).

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98——PART II ENFORCEABLE STANDARDS

To what extent is the behavior endangering the life or seriously compromising

the well-being of the client/patient?

For this particular patient, will the discomfort and distress of the aversive

treatment outweigh its potential positive effects?

To what extent is the urgency defined by the needs of third parties rather than

the client/patient? (Standards 3.05, Multiple Relationships; 3.07, Third-Party

Requests for Services; and 3.08, Exploitative Relationships)

Am I competent to administer the aversive treatment? (Standards 2.01a,

Boundaries of Competence, and 2.05, Delegation of Work to Others)

If aversive treatment is the only remaining option to best serve the needs of

the client/patient, how can harm be minimized?

Have I established appropriate monitoring procedures and termination criteria?

􀀵 Prescribing psychologists trained in addiction treatments opened a group practice to

provide assessment and individual and group therapy for substance abuse and comorbid

disorders. Occasionally, some clients who were long-term cocaine users could not

overcome their cravings despite positive responses to therapy. In such cases, the team

would offer the client a chemical aversion therapy with empirical evidence of treatment

efficacy. The therapy was supervised by a member of the team who was a prescribing

psychologist and who had acquired additional training in this technique (see

also Standard 2.01, Competence).

􀀵 Prior to initiating the aversion therapy, clients/patients were required to undergo a

physical examination by a physician to rule out those for whom the treatment posed

a potential medical risk. The treatment consisted of drinking a saltwater solution

containing a chemical that would induce nausea. Saltwater was used to avoid creating

a negative association with water. As soon as the client began to feel nauseated,

he or she was instructed to ingest a placebo form of crack cocaine using drug paraphernalia.

A bucket was available for vomiting. Patients were monitored by a physician

assistant and the prescribing psychologist during the process and recovery for

any medical or iatrogenic psychological side effects (Standard 3.09, Cooperation With

Other Professionals). Following the recommended minimum number of sessions,

patients continued in individual psychotherapy, and positive and negative reactions to

the aversion therapy continued to be monitored (see Bordnick et al., 2004).

Need to Know: When HMOs

Refuse to Extend Coverage

When health maintenance organizations refuse psychologists’ request to extend coverage for

clients/patients whose reimbursement quotas have been reached, psychologists may be in

violation of Standard 3.04 if they (a) did not take reasonable steps at the outset of therapy to

estimate and communicate to patients and their insurance company the number of sessions

anticipated, (b) did not familiarize themselves with the insurers’ policy, (c) recognized a need

for continuing treatment but did not communicate with insurers in an adequate or timely

fashion, or (d) were unprepared to handle client/patient response to termination of services.

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Chapter 6 Standards on Human Relations——99

Often, violation of Standard 3.04 will occur in connection with the violation of

other standards in this code that detail the actions required to perform psychological

activities in an ethically responsible manner. For example:

􀀴 Providing testimony on the poor parenting skills of an individual whom the psychologist

has never personally examined that contributed to that individual’s loss of child

custody (Standard 9.01b, Bases for Assessments)

􀀴 Engaging in a sexual relationship with a current therapy client/patient that was a

factor leading to the breakup of the client’s/patient’s marriage (Standard 10.05,

Sexual Intimacies With Current Therapy Clients/Patients)

􀀴 Asking students to relate their personal experience in psychotherapy to past and current

theories on mental health treatment when this requirement was not stipulated in

admissions or program materials, causing some students to drop out of the program

(Standard 7.04, Student Disclosure of Personal Information)

􀀴 Deceiving a research participant about procedures that the investigator expected

would cause some physical pain (Standard 8.07b, Deception in Research)

􀀴 Invalidating the life experience of clients from diverse cultural backgrounds by defining

their cultural values or behaviors as deviant or pathological and denying them culturally

appropriate care (D. W. Sue & Sue, 2003; Standard 2.01b, Boundaries of Competence).

Some contexts require more stringent protections against harm. For example,

psychologists working within institutions that use seclusion or physical restraint

techniques to treat violent episodes or other potentially injurious patient behaviors

must ensure that these extreme methods are employed only upon evidence of their

effectiveness, when other treatment alternatives have failed, and when the use of

such techniques is in the best interest of the patient and not for punishment, for

staff convenience or anxiety, or to reduce costs (Jerome, 1998).

􀀴 The director of psychological services for a children’s state psychiatric inpatient ward

approved the employment of time-out procedures to discipline patients who were disruptive

during educational classes. A special room was set up for this purpose. The director

did not, however, set guidelines for how the time-out procedure should be implemented.

For example, he failed to set limits on the length of time a child could be kept in the room

and not require staff monitoring, did not ensure the room was protected against fire

hazard, and did not develop policies that would permit patients to leave the room for

appropriate reasons. The director was appalled to learn that staff had not monitored

a 7-year-old who was kept in the room for over an hour and was discovered crying and

self-soiled (see, e.g., Dickens v. Johnson County Board of Education, 1987; Goss v. Lopez,

1975; Hayes v. Unified School District, 1989; Yell, 1994).

Psychotherapy and Counseling Harms

Psychologists should also be aware of psychotherapies or counseling techniques

that may cause harm (Barlow, 2010). If psychological interventions are powerful

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100——PART II ENFORCEABLE STANDARDS

enough to improve mental health, it follows that they can be equally effective in worsening

it. In the normative practice of mental health treatment, the diversity of patient/

client mental health needs and the fluid nature of differential diagnosis will mean that

some therapeutic approaches will fail to help alleviate a mental health problem. In such

circumstances, psychologists will turn to other techniques, seek consultation, or offer

an appropriate referral. In other circumstances, negative symptoms are expected to

increase then subside during the natural course of evidence-based treatment (e.g.,

exposure therapy). When treating naturally deteriorating conditions (e.g., Alzheimer’s

disease), a worsening of symptoms does not necessarily indicate treatment harms

(Dimidjian & Hollon, 2010). By contrast, harmful psychotherapies are defined as those

that produce outcomes worse than what would have occurred without treatment

(Dimidjian & Hollon, 2010; Lilienfeld, 2007). Such harmful effects are easiest to detect

for mental health problems whose natural course is constant. In all these circumstances,

failure to terminate treatment when it becomes clear that continuation would

be harmful is a violation of Standard 3.04 and Standard 10.10a, Terminating Therapy.

Need to Know: How to Detect Harm

in Psychotherapy and Counseling

Psychologists should be aware of the evolving body of knowledge on potential contributors

to the harmful effects of psychotherapy and keep in mind the following suggestions

drawn from Beutler, Blatt, Alimohamed, Levy, and Angtuaco (2006), Castonguay, Boswell,

Constantino, Goldfried, and Hill (2010), and Lilienfeld (2007):

Obtain training in and keep up to date on the flexible use of interventions and

treatment alternatives to avoid premature use of clinical interpretations, rigid theoretical

frameworks, and singular treatment modalities.

Be familiar with the degree to which each client/patient and treatment setting match

those reported for a specific EBP and look for multiple knowledge sources as support

for different approaches (readers may also want to refer to the Need to Know section

on “Navigating the Online Search for Evidence-Based Practices” in Chapter 5).

Monitor change suggesting client/patient deterioration or lack of improvement;

continuously evaluate what works and what interferes with positive change.

Attend to treatment-relevant characteristics such as culture, sexual orientation,

religious beliefs, and disabilities and be aware of the possibility of over- or underdiagnosing

these clients’/patients’ mental health needs.

Carefully attend to client’s/patient’s disclosures of frustration with treatment and

use the information self-critically to evaluate the need to modify diagnosis, adjust

treatment strategy, or strengthen relational factors that may be jeopardizing the

therapeutic alliance.

Equipoise and Randomized Clinical Trials

Important questions of treatment efficacy and effectiveness driving the conduct

of randomized clinical trials (RCTs) for mental health treatments raise, by their very

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Chapter 6 Standards on Human Relations——101

nature, the possibility that some participants will fail to respond to experimental

treatment conditions or experience a decline in mental health during the trial. To

comply with Standard 3.04, research psychologists should develop procedures to

identify and address such possibilities. Such steps can include (a) scientifically and

clinically informed inclusion and exclusion criteria for patient participation, (b) the

establishment of a data safety monitoring board to evaluate unanticipated risks that

may emerge during a clinical trial, and (c) prior to the initiation of the research,

establishing criteria based on anticipated risks for when a trial should be stopped to

protect the welfare of participants. For additional information on guidance from the

Office of Human Research Protections, readers can refer to http://www.hhs.gov/

ohrp/policy/advevntguid.html.

􀀵 There is professional and scientific disagreement over the risks and benefits of

prescribing methylphenidate (e.g., brand name Ritalin) for treatment of attentiondeficit/

hyperactivity disorder (ADHD) in children less than 6 years of age. An interdisciplinary

team of behavioral and prescribing psychologists sought to empirically

test the advantage of adding psychopharmaceutical treatment to CBT for 3- to

5-year-old children previously diagnosed with ADHD. To avoid unnecessarily exposing

children to the potential side effects of medication, the team decided that preschoolers

would first participate in a multi-week parent training and behavioral

treatment program and that only those children whose symptoms did not significantly

improve with the behavioral intervention would continue on to the medication

clinical trial.

3.05 Multiple Relationships

(a) A multiple relationship occurs when a psychologist is in a professional role with a person and

(1) at the same time is in another role with the same person, (2) at the same time is in a relationship

with a person closely associated with or related to the person with whom the psychologist

has the professional relationship, or (3) promises to enter into another relationship in the future

with the person or a person closely associated with or related to the person. A psychologist

refrains from entering into a multiple relationship if the multiple relationship could reasonably be

expected to impair the psychologist’s objectivity, competence, or effectiveness in performing his

or her functions as a psychologist, or otherwise risks exploitation or harm to the person with

whom the professional relationship exists.

Multiple relationships that would not reasonably be expected to cause impairment or risk

exploitation or harm are not unethical.

Individual psychologists may perform a variety of roles. For example, during

the course of a year, a psychologist might see clients/patients in private practice,

teach at a university, provide consultation services to an organization, and conduct

research. In some instances, these multiple roles will involve the same person or

persons who have a close relationship with one another and may be concurrent or

sequential.

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102——PART II ENFORCEABLE STANDARDS

Not All Multiple Relationships Are Unethical

Multiple relationships that would not reasonably be expected to cause impairment

or risk exploitation or harm are not unethical. For example, it is not unethical

for psychologists to serve as clinical supervisors or dissertation mentors for students

enrolled in one of their graduate classes because supervision, mentoring, and

teaching are all educational roles.

Standard 3.05 does not prohibit attendance at a client’s/patient’s, student’s,

employee’s, or employer’s family funeral, wedding, or graduation; the participation

of a psychologist’s child in an athletic team coached by a client/patient; gift giving

or receiving with those with whom one has a professional role; or entering into a

social relationship with a colleague as long as these relationships would not reasonably

be expected to lead to role impairment, exploitation, or harm. Incidental

encounters with clients/patients at religious services, school events, restaurants,

health clubs, or similar places are also not unethical as long as psychologists react

to these encounters in a professional manner. Nonetheless, psychologists should

always consider whether the particular nature of a professional relationship might

lead to a client’s/patient’s misperceptions regarding an encounter. If so, it is advisable

to keep a record of such encounters. For example:

􀀵 A client with a fluctuating sense of reality coupled with strong romantic transference

feelings for a treating psychologist misinterpreted two incidental encounters with his

psychologist as planned romantic meetings. The client subsequently raised these incidents

in a sexual misconduct complaint against the psychologist. The psychologist’s

recorded notes, made immediately following each encounter, were effective evidence

against the invalid accusations.

Posttermination Nonsexual Relationships

The standard does not have an absolute prohibition against posttermination

nonsexual relationships with persons with whom psychologists have had a previous

professional relationship. However, such relationships are prohibited if the

posttermination relationship was promised during the course of the original

relationship or if the individual was exploited or harmed by the intent to have the

posttermination relationship. Psychologists should be aware that posttermination

relationships can become problematic when personal knowledge acquired

during the professional relationship becomes relevant to the new relationship

(see S. K. Anderson & Kitchener, 1996; Sommers-Flanagan, 2012).

􀀵 A psychologist in independent practice abruptly terminated therapy with a patient

who was an editor at a large publishing company so that the patient could review a

book manuscript that the psychologist had submitted to the company.

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Chapter 6 Standards on Human Relations——103

Clients in Individual and Group Therapy

In most instances, treating clients/patients concurrently in individual and

group therapy does not represent a multiple relationship because the practitioner

is working in a therapeutic role in both contexts (R. E. Taylor & Gazda, 1991), and

Standard 3.05 does not prohibit such practice. Psychologists providing individual

and group therapy to the same clients/patients should consider instituting special

protections against inadvertently revealing to a therapy group information shared

by a client/patient in individual sessions. As in all types of professional practice,

psychologists should avoid recommending an additional form of therapy based on

the psychologist’s financial interests rather than the client’s/patient’s mental health

needs (Knauss & Knauss, 2012; Standard 3.06, Conflict of Interest).

Need to Know: Ethical “Hot Spots”

of Combined Therapy

Brabender and Fallon (2009) have identified ethical “hot spots” of combined therapy that

should be addressed at the outset of plans to engage clients/patients in individual and

group therapy. First, clients/patients should know that they have a choice in being offered

an additional therapy beyond what they expected, and their concerns about costs in time

and money should be respected and discussed (Standard 10.01, Informed Consent to

Therapy; 10.03, Group Therapy). Second, the psychologists should describe how private

information disclosed in individual therapy will be protected from transfer during group

sessions (Standard 4.02, Discussing the Limits of Confidentiality). Finally, psychologists

should explain their policies on client/patient decisions to choose to terminate one of the

treatment modalities (Standard 10.10a, Terminating Therapy).

Judging the Ethicality of Multiple Roles

Several authors have provided helpful decision-making models for judging

whether a multiple relationship may place the psychologist in violation of Standard

3.04 (Brownlee, 1996; Gottlieb, 1993; Oberlander & Barnett, 2005; Younggren &

Gottlieb, 2004). The majority looks at multiple relationships in terms of a continuum

of risk. From these models, the ethical appropriateness of a multiple relationship

becomes increasingly questionable with

increased incompatibility in role functions and objectives;

the greater power or prestige the psychologist has over the person with whom

there is a multiple role;

the greater the intimacy called for in the roles;

the longer the role relationships are anticipated to last;

the more vulnerable the client/patient, student, supervisee, or other subordinate

is to harm; and

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104——PART II ENFORCEABLE STANDARDS

the extent to which engaging in the multiple relationship meets the needs of

the psychologist rather than the needs of the client/patient.

Potentially Unethical Multiple Relationships

Entering Into Another Role

Psychologists may encounter situations in which the opportunity to enter a new

relationship emerges with a person with whom they already have an established

professional role. The following examples illustrate multiple relationships that,

with rare exception, would be prohibited by Standard 3.05a because each situation

could reasonably be expected to impair psychologists’ ability to competently and

objectively perform their roles or lead to exploitation or harm.

􀀴 A psychologist agreed to see a student in the psychologist’s introductory psychology

course for brief private counseling for test anxiety. At the end of the semester, to avoid

jeopardizing the student’s growing academic self-confidence, the psychologist refrained

from giving the student a legitimate low grade for poor class performance. The psychologist

should have anticipated that the multiple relationship could impair her objectivity and

effectiveness as a teacher and create an unfair grading environment for the rest of the class.

􀀴 A company hired a psychologist for consultation on how to prepare employees for a

shift in management anticipated by the failing mental health of the chief executive

officer (CEO). A few months later, the psychologist agreed to a request by the board

of directors to counsel the CEO about retiring. The CEO did not want to retire and told

the psychologist about the coercive tactics used by the board. The psychologist realized

too late that this second role undermined both treatment and consultation

effectiveness because the counseling role played by the psychologist would be viewed

as either exploitative by the CEO or as disloyal by the board of directors.

􀀴 A school psychologist whose responsibilities in the school district included discussing

with parents the results of their children’s psychoeducational assessments regularly

recommended to parents that they bring their children to his private practice for

consultation and possible therapy.

􀀴 As part of their final class assignment, a psychologist required all students in her

undergraduate psychology class to participate in a federally funded research study

that she was conducting on college student drinking behaviors.

􀀴 A psychologist treating an inmate for anxiety disorder in a correctional facility agreed

with a request by the prison administrator to serve on a panel determining the

inmate’s parole eligibility (Anno, 2001).

􀀴 A graduate student interning at an inpatient psychiatric hospital asked her patients if

they would agree to participate in her dissertation research.

􀀴 An applied developmental psychologist conducting interview research on moral

development and adolescent health risk behaviors, often found herself giving advice

to adolescent female participants who asked for her help during the interviews.

Forensic Roles

Forensic psychologists may be called upon for a variety of assessment roles that

differ in their goals and responsibilities from those of treating psychologists.

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Chapter 6 Standards on Human Relations——105

Whereas the responsibility of the treating psychologist is to help clients/patients

achieve mental health, the responsibility of forensic psychologists serving as experts

for the court, the defense, or plaintiff is to provide objective information to assist

the finder of facts in legal determinations. In most instances, psychologists who take

on both roles concurrently or sequentially will be in violation of Standard 3.05a.

For example, in the treatment context, the format, information sought, and

psychologist–client/patient relationship are guided by the psychologist’s professional

evaluation of client/patient needs. Information obtained in a standardized or

unstructured manner or in response to practitioner empathy and other elements of

the therapeutic alliance is a legitimate means of meeting treatment goals.

However, when mixed with the forensic role, the subjective nature of such inquiries

and the selectivity of information obtained impair the psychologist’s objectivity

and thus ability to fulfill forensic responsibilities. Moreover, the conflicting objectives

of the treating and forensic roles will be confusing and potentially intimidating to

clients/patients, thereby undermining the psychologist’s effectiveness in functioning

under either role. Gottlieb and Coleman (2012) advise forensic psychologists to play

only one role in legal matters and to notify parties if a role change is contemplated.

􀀴 A forensic psychologist was hired by the court to conduct a psychological evaluation

for a probation hearing of a man serving a jail sentence for spousal abuse. At the end

of the evaluation, the psychologist suggested that if the inmate were released, he and

his wife should consider seeing her for couple’s therapy.

Bush et al. (2006) suggest that one potential exception to multiple relationships

in forensic contexts may be seen in psychologists who transition from the role of

forensic evaluator to trial consultant. For example, in some contexts it might be

ethically permissible for a psychologist originally retained by a defense attorney to

evaluate a client to also perform consultative services to the attorney regarding the

testimony of other psychologists during a trial if (a) the psychologist provided

only an oral report on his or her diagnostic impressions and (b) the psychologist

would not be called on to provide court testimony. Psychologists should, however,

approach such a multiple relationship with caution if, by ingratiating themselves

with the attorney, they intentionally or unintentionally bias their evaluation or

otherwise violate Standard 3.05a, Multiple Relationships, or 3.06, Conflict of Interest.

(For additional discussion of the role of forensic experts, see the Hot Topics in

Chapters 8 and 12 on psychologists providing testimony in courts.)

Personal–Professional Boundary Crossings

Involving Clients/Patients, Students,

Research Participants, and Subordinates

Boundaries serve to support the effectiveness of psychologists’ work and create

a safe place for clients/patients, students, employees, and other subordinates to

benefit from the psychologists’ services (Burian & Slimp, 2000; Russell & Peterson,

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106——PART II ENFORCEABLE STANDARDS

1998). Boundaries protect against a blurring of personal and professional domains

that could jeopardize psychologists’ objectivity and confidence of those with whom

they work that psychologists will act in their best interests. Unethical multiple relationships

often emerge after psychologists have engaged in a pattern that “progresses

from apparently benign and perhaps well-intended boundary crossings to

increasingly intrusive and harmful boundary violations and multiple relationships”

(Oberlander & Barnett, 2005, p. 51). Boundary crossings can thus place psychologists

on a slippery slope leading to ethical misconduct (Gutheil & Gabbard, 1993;

Norris, Gutheil, & Strasburger, 2003; Sommers-Flanagan, 2012).

Clients/patients, students, research participants, and supervisees have less experience,

knowledge, and power compared with psychologists providing assessment, treatment,

teaching, mentoring, or supervision. Consequently, they are unlikely to recognize

inappropriate boundary crossings or to express their concerns. It is the psychologist’s

responsibility to monitor and ensure appropriate boundaries between professional and

personal communications and relationships (Gottlieb, Robinson, & Younggren, 2007).

Sharing aspects of their personal history or current reactions to a situation with

those they work with is not unethical if psychologists limit these communications

to meet the therapeutic, educational, or supervisory needs of those they serve.

􀀵 A graduate student expressed to his dissertation mentor his feelings of inadequacy

and frustration upon learning that a manuscript he had submitted for publication was

rejected. The mentor described how she often reacted similarly when first receiving

such information but framed this disclosure within a “lesson” for the student on rising

above the initial emotion to objectively reflect on the review and improve his chances

of having a revised manuscript accepted.

􀀵 A psychologist in private practice was providing CBT to help a client conquer feelings

of inadequacy and panic attacks that were interfering with her desired career

advancement. After several sessions, the psychologist realized that the client’s distorted

belief regarding the ease with which other people and the psychologist, in

particular, attained their career goals was interfering with the effectiveness of the

treatment. The psychologist shared with the client a brief personal story regarding

how he experienced and reacted to a career obstacle, limiting the disclosure to elements

the client could use in framing her own career difficulties.

Boundary crossings can become boundary violations when psychologists share personal

information with clients/patients, students, or employees to satisfy their own needs.

􀀴 A psychologist repeatedly confided to his graduate research assistant about the economic

strains his marriage was placing on his personal and professional life. After

several weeks, the graduate student began to pay for the psychologist’s lunches when

they were delivered to the office.

􀀴 A psychologist providing services at a college counseling center was having difficulties

with her own college-aged son’s drinking habits. She began to share her concerns

about her son with her clients and sometimes asked their advice.

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Chapter 6 Standards on Human Relations——107

Research

Boundary crossings can also lead to bidirectional coercion, exploitation, or

harm. For example, the intimacy between researchers and study participants inherent

in ethnographic and participant observation research can create ambiguous or

blurred personal–professional boundaries that can threaten the validity of data

collected (Fisher, 2004, 2011). Study participants may feel bound by a personal

relationship with an investigator to continue in a research project they find distressing,

or investigators may feel pressured to yield to participant demands for involvement

in illegal behaviors or for money or other resources above those allocated for

participation in the research (Singer et al., 1999).

􀀴 A psychologist was conducting ethnographic research on the lives of female sex workers

who were also raising young children. In an effort to establish a sense of trust with

the sex workers, she spent many months in the five-block radius where they worked,

sharing stories with them about her own parenting experiences. One day, when the

police were conducting a drug raid in the area, a participant the psychologist had

interviewed numerous times begged the psychologist to hold her marijuana before

the police searched her, crying that she would lose her child if the drugs were discovered.

The psychologist felt she had no choice but to agree to hide the drugs because

of the personal worries about the safety of her own children that she had shared with

the participant (adapted from Fisher, 2011).

Nonsexual Physical Contact

Nonsexual physical contact with clients/patients, students, or others over whom

the psychologist has professional authority can also lead to role misperceptions that

interfere with the psychologist’s professional functions. While Standard 3.05 does

not prohibit psychologists from hugging, handholding, or putting an arm around

those with whom they work in response to a special event (e.g., graduation, termination

of therapy, promotion), or showing empathy for emotional crises (e.g.,

death in the family, recounting of an intense emotional event), such actions can be

the first step toward an easing of boundaries that could lead to an unethical multiple

relationship.

Whenever such circumstances arise, psychologists should evaluate, before

they act, the appropriateness of the physical contact by asking the following

questions:

Is the initiation of physical contact consistent with the professional goals of

the relationship?

How might the contact serve to strengthen or jeopardize the future functioning

of the psychologist’s role?

How will the contact be perceived by the recipient?

Does the act serve the immediate needs of the psychologist rather than the

immediate or long-term needs of the client/patient, student, or supervisee?

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108——PART II ENFORCEABLE STANDARDS

Is the physical contact a substitute for more professionally appropriate

behaviors?

Is the physical contact part of a continuing pattern of behavior that may

reflect the psychologists’ personal problems or conflicts?

Need to Know: Professional Boundaries

and Self-Disclosure Over the Internet

The Internet has complicated psychologists’ control over access to personal information.

Psychologists can control some information disclosed on the Internet through

carefully crafted professional blogs, participation on professional or scientific listservs,

and credentials or course curricula posted on individual or institutional websites.

However, accidental self-disclosure (Zur, Williams, Lehavot, & Knapp, 2009) can occur

when clients/patients, students, employees, or others (a) pay for legal online background

checks that may include information on divorce or credit ratings, (b) conduct

illegal searches of cell phone records, or (c) use search engines to find information that

the psychologist may not be aware is posted online. Even when psychologists refuse

“friending” requests, it is increasingly easy for individuals to find information on social

networks such as Facebook through the millions of interconnected links and “mutual

friends” who may have personal postings from and photos of the psychologist on their

websites (Luo, 2009; L. Taylor, McMinn, Bufford, & Change, 2010; Zur et al., 2009).

Given the risks of accidental self-disclosure, psychologists should consider the following

to limit access to personal information (Barnett, 2008; Lehavot, Barnett, & Powers,

2010; Nicholson, 2011):

Set one’s social network settings to restrict access to specifically authorized

visitors only.

Consider whether posted personal information, if accessed, would cause harm to

those with whom you work; undermine your therapeutic, teaching, consultation, or

research effectiveness; or compromise the public’s trust in the discipline.

Periodically search one’s name online using different combinations (e.g., Dr. Jones,

Edward Jones, Jones family).

Consult with experts on how to remove personal or inaccurate information from

the Internet.

When appropriate discuss your Internet policies during informed consent or the

beginning of other professional relationships (see “Need to Know: Setting an Internet

Search and Social Media Policy During Informed Consent” in Chapter 13).

Relationships With Others

Psychologists also encounter situations in which a person closely associated with

someone with whom they have a professional role seeks to enter into a similar professional

relationship. For example, the roommate of a current psychotherapy client/

patient might ask the psychologist for an appointment to begin psychotherapy. A

CEO of a company that hires a psychologist to conduct personnel evaluations might

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Chapter 6 Standards on Human Relations——109

ask the psychologist to administer psychological tests to the CEO’s child to determine

whether the child has a learning disability. With few exceptions, entering into

such relationships would risk a violation of Standard 3.05a because it could reasonably

be expected that the psychologist’s ability to make appropriate and objective

judgments would be impaired, which in turn would jeopardize the effectiveness of

services provided and result in harm.

Receiving referrals from current or recent clients/patients should raise ethical

red flags. In many instances, accepting into treatment a friend, relative, or others

referred by a current client can create a real or perceived intrusion on the psychologist–

patient relationship. For example, a current client/patient may question whether the

psychologist has information about him or her gained from the person he or she

referred or whether the psychologist is siding with one person or the other if there

is a social conflict. Psychologists must also guard against exploiting clients/patients

by explicitly or implicitly encouraging referrals to expand their practice (see also

Standard 3.06, Conflict of Interest).

Some have suggested that treating psychologists should consider a referral from

a current client/patient in the same way they would evaluate the therapeutic meaning

of a “gift” (E. Shapiro & Ginzberg, 2003). In all circumstances, psychologists

must evaluate the extent to which accepting a referral can impair their objectivity

and conduct of their work or lead to exploitation or harm. One way of addressing

this issue is to clearly state to current patients the psychologist’s policy of not

accepting patient referrals and, if a situation arises requiring an immediate need for

treatment, to provide a professional referral to another psychologist (see also

Standard 2.02, Providing Services in Emergencies).

When practicing psychologists receive referrals from former clients/patients, it is

prudent to consider (a) whether the former client/patient may need the psychologist’s

services in the future, (b) whether information obtained about the new referral

during the former client’s/patient’s therapy is likely to impair the psychologist’s

objectivity, and (c) the extent to which the new referral’s beliefs about the former

client’s/patient’s relationship with the psychologist is likely to interfere with treatment

effectiveness.

Preexisting Personal Relationships

Psychologists may also encounter situations in which they are asked to take on a

professional role with someone with whom they have had a preexisting personal

relationship. Such multiple relationships are often unethical because the preexisting

relationship would reasonably be expected to impair the psychologist’s objectivity

and effectiveness.

􀀴 A psychologist agrees to spend a few sessions helping his nephew overcome anxiety

about going to school.

􀀴 At a colleague’s request, a psychologist agrees to administer a battery of tests to

assess whether the colleague has adult attention deficit disorder.

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110——PART II ENFORCEABLE STANDARDS

Sexual Multiple Relationships

Sexual relationships with individuals with whom psychologists have a current

professional relationship are always unethical. Because of the strong potential for

harm involved in such multiple relationships, they are specifically addressed in

several standards of the Ethics Code that will be covered in greater detail in

Chapters 10 and 13 (Standards 7.07, Sexual Relationships With Students and

Supervisees; 10.05, Sexual Intimacies With Current Therapy Clients/Patients; 10.06,

Sexual Intimacies With Relatives or Significant Others of Current Therapy Clients/

Patients; 10.07, Therapy With Former Sexual Partners; and 10.08, Sexual Intimacies

With Former Therapy Clients/Patients).

“Reasonably Expected”

It is important to note that the phrase “could reasonably be expected” indicates

that violations of Standard 3.05a may be judged not only by whether actual impairment,

harm, or exploitation has occurred but also by whether most psychologists

engaged in similar activities in similar circumstances would determine that entering

into such a multiple relationship would be expected to lead to such harms.

􀀵 A judge asked a psychologist who had conducted a custody evaluation to provide

6-month mandated family counseling for the couple involved followed by a reevaluation

for custody. The psychologist explained to the judge that providing family counseling

to individuals whose parenting skills the psychologist would later have to

evaluate could reasonably be expected to impair her ability to form an objective

opinion independent of knowledge gained and the professional investment made in

the counseling sessions. She also explained that such a multiple relationship could

impair her effectiveness as a counselor if the parents refrained from honest engagement

in the counseling sessions for fear that comments made would be used against

them during the custody assessment. The judge agreed to assign the family to another

psychologist for counseling.

Unavoidable Multiple Relationships

In some situations, it may not be possible or reasonable to avoid multiple relationships.

Psychologists working in rural communities, small towns, American

Indian reservations, or small insulated religious communities or who are qualified

to provide services to members of unique ethnic or language groups for which

alternative psychological services are not available would not be in violation of this

standard if they took reasonable steps to protect their objectivity and effectiveness

and the possibility of exploitation and harm (Werth et al., 2010).

Such steps might include seeking consultation by phone from a colleague to

help ensure objectivity and taking extra precautions to protect the confidentiality

of each individual with whom the psychologist works. Psychologists can also

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Chapter 6 Standards on Human Relations——111

explain to individuals involved the ethical challenges of the multiple relationships,

describe the steps the psychologist will take to mitigate these risks, and

encourage individuals to alert the psychologist to multiple relational situations of

which the psychologist might not be aware and that might place his or her effectiveness

at risk.

􀀵 A rabbi in a small orthodox Jewish community also served as the community’s sole

licensed clinical psychologist. The psychologist was careful to clearly articulate to his

clients the separation of his role as a psychologist and his role as their rabbi. His work

benefited from his ability to apply his understanding of the orthodox faith and community

culture to help clients/patients with some of the unique psychological issues

raised. He had been treating a young woman in the community for depression when

it became clear that a primary contributor to her distress was her deep questioning of

her faith. The psychologist knew from his years in the community that abandoning

orthodox tenets would most likely result in the woman being ostracized by her family

and community. As a rabbi, the psychologist had experience helping individuals

grapple with doubts about their faith. However, despite the woman’s requests, he was

unwilling to engage in this rabbinical role as a part of the therapy, believing that helping

the woman maintain her faith would be incompatible with his responsibility as a

psychologist to help her examine the psychological facets of her conflicted feelings.

The rabbi contacted the director of an orthodox rabbinical school who helped him

identify an advanced student with experience in Jewish communal service who was

willing to come to the community once a week to provide a seminar on Jewish studies

and meet individually with congregants about issues of faith. The psychologist

explained the role conflict to his patient. They agreed that she would continue to see

the psychologist for psychotherapy and meet with the visiting rabbinical student to

discuss specific issues of faith. Readers may also wish to refer to the Hot Topic in

Chapter 13 on the role of religion and spirituality in psychotherapy.

Correctional and Military Psychologists

Psychologists working in correctional settings and those enlisted in the military

often face unique multiple relationship challenges. In some prisons, correctional

administrators believe that all employees should provide services as officers. As

detailed by Weinberger and Sreenivasan (2003), psychologists in such settings may

be asked to search for contraband, use a firearm, patrol to prevent escapes, coordinate

inmate movement, and deal with crises unrelated to their role as a psychologist.

Any one of these roles has the potential to undermine the therapeutic

relationship a psychologist establishes with individual inmates by blurring the roles

of care provider and security officer. Such potentially harmful multiple relationships

are also inconsistent with the Standards for Psychological Services in Jails,

Prisons, Correctional Facilities, and Agencies (Althouse, 2000).

As required by Standard 1.03, Conflicts Between Ethics and Organizational

Demands, prior to taking a position as a treating psychologist or whenever correctional

psychologists are asked to engage in a role that will compromise their health

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112——PART II ENFORCEABLE STANDARDS

provider responsibilities, they should clarify the nature of the conflict to the administrator,

make known their commitment to the Ethics Code, and attempt to resolve

the conflict by taking steps to ensure that they do not engage in multiple roles that

will interfere with the provision of psychological services.

􀀵 A psychologist working in a correctional facility had successfully established his primary

role as that of mental health treatment provider with both prison officials and

inmates. He was not required to search his patients for contraband or to perform any

other security-related activities. As required of all facility staff, he received training in

the use of firearms and techniques to disarm prisoners who had weapons. On one

occasion, several newly admitted inmates suddenly began to attack some of the older

prisoners with homemade knives. As one of the few correctional staff members present

at the scene, the psychologist assisted the security staff in disarming the inmates.

Although none of the attacking inmates were in treatment with him, he did discuss

the incident with his current patients to address any concerns they might have about

the therapeutic relationship.

Psychologists in the military face additional challenges (Kennedy & Johnson,

2009). W. B. Johnson, Bacho, Heim, and Ralph (2006) highlight multiple role obligations

that may create a conflict between responsibilities to individual military

clients/patients and to their military organization: (a) as commissioned officers,

psychologists’ primary obligation is to the military mission; (b) embedded psychologists

must promote the fighting power and combat readiness of individual

military personnel and the combat unit as a whole; (c) since many military psychologists

are the sole mental health providers for their unit, there is less room for

choice of alternative treatment providers; (d) there is less control and choice

regarding shifts between therapeutic and administrative role relationships (e.g.,

seeing as a patient a member about whom the psychologist previously had to render

an administrative decision); and (e) like rural communities, military communities

are often small, with military psychologists having social relationships with

individuals who may at some point become patients.

To minimize the potential harm that could emerge from such multiple relationships,

Johnson et al. (2006) suggest that military psychologists (a) strive for a neutral

position in the community, avoiding high-profile social positions; (b) assume

that every member of the community is a potential client/patient and attempt to

establish appropriate boundaries accordingly, for example, limiting self-disclosures

that would be expected in common social circumstances; (c) provide informed

consent immediately if a nontherapeutic role relationship transitions into a therapeutic

one; (d) be conservative in the information one “needs to know” in the

therapeutic role to avoid to the extent feasible threats to confidentiality that may

emerge when an administrative role is required; (e) collaborate with clients/

patients on how best to handle role transitions when possible and appropriate; and

(f) carefully document multiple role conflicts, how they were handled, and the

rationale for such decisions.

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Chapter 6 Standards on Human Relations——113

(b) If a psychologist finds that, due to unforeseen factors, a potentially harmful multiple relationship

has arisen, the psychologist takes reasonable steps to resolve it with due regard for the best

interests of the affected person and maximal compliance with the Ethics Code.

There will be instances when psychologists discover that they are involved in a

potentially harmful multiple relationship of which they had been unaware. Standard

3.05b requires that psychologists take reasonable steps to resolve the potential harms

that might arise from such relationships, recognizing that the best interests of the

affected person and maximal compliance with other standards in the Ethics Code

may sometimes require psychologists to remain in the multiple roles.

􀀵 A military psychologist provided therapy to an enlisted officer who was ordered to enter

treatment for difficulties in job-related performance. During treatment, the client and

psychologist were assigned to a field exercise in which the client would be under

the psychologist’s command. To reassign the client to a different officer for the exercise,

the psychologist would need to speak with a superior who was not a mental health

worker. Recognizing that the client’s involvement in therapy would have to be revealed

in such a discussion, the psychologist explained the situation to the enlisted member

and asked permission to discuss the situation with her superiors. The client refused to

give permission. The psychologist was the only mental health professional on the base,

so transferring the client to another provider was not an option. The psychologist therefore

developed a specific plan with the client for how they would relate to each other

during the field exercise and how they would discuss in therapy issues that arose. (This

case is adapted from one of four military cases provided by Staal & King, 2000.)

􀀵 A psychologist responsible for conducting individual assessments of candidates for an

executive-level position discovered that one of the candidates was a close friend’s

husband. Because information about this prior relationship was neither confidential

nor harmful to the candidate, the psychologist explained the situation to company

executives and worked with the organization to assign that particular promotion

evaluation to another qualified professional.

􀀵 A psychologist working at a university counseling center discovered that a counseling

client had enrolled in a large undergraduate class the psychologist was going to teach.

The psychologist discussed the potential conflict with the client and attempted to help

him enroll in a different class. However, the client was a senior and needed the class

to complete his major requirements. In addition, there were no appropriate referrals

for the student at the counseling center. Without revealing the student’s identity, the

psychologist discussed her options with the department chair. They concluded that

because the class was very large, the psychologist could take the following steps to

protect her objectivity and effectiveness as both a teacher and a counselor: (a) a

graduate teaching assistant would be responsible for grading exams and for calculating

the final course grade based on the average of scores on the exams and (b) the

psychologist would monitor the situation during counseling sessions and seek consultation

if problems arose.

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114——PART II ENFORCEABLE STANDARDS

(c) When psychologists are required by law, institutional policy, or extraordinary circumstances

to serve in more than one role in judicial or administrative proceedings, at the outset they

clarify role expectations and the extent of confidentiality and thereafter as changes occur. (See

also Standards 3.04, Avoiding Harm, and 3.07, Third-Party Requests for Services.)

Standard 3.05c applies to instances when psychologists are required to serve in

more than one role in judicial or administrative proceedings because of institutional

policy or extraordinary circumstances. This standard does not permit psychologists

to take on these multiple roles if such a situation can be avoided. When

such multiple roles cannot be avoided, Standard 3.05c requires, as soon as possible

and thereafter as changes occur, that psychologists clarify to all parties involved the

roles that the psychologist is expected to perform and the extent and limits of confidentiality

that can be anticipated by taking on these multiple roles.

In most situations, psychologists are expected to avoid multiple relationships

in forensically relevant situations or to resolve such relationships when they

unexpectedly occur (Standard 3.05a and b). When such circumstances arise (e.g.,

performing a custody evaluation and then providing court-mandated family

therapy for the couple involved), the conflict can often be resolved by explaining

to a judge or institutional administrator the ethically problematic nature of the

multiple relationship (Standards 1.02, Conflicts Between Ethics and Law,

Regulations, and Other Governing Legal Authority; 1.03, Conflicts Between

Ethics and Organizational Demands).

􀀵 A psychologist in independent practice became aware that his neighbor had begun dating

one of the psychologist’s psychotherapy patients. Although telling the patient about

the social relationship could cause distress, it was likely that the patient would find out

about the relationship during conversations with the neighbor. The psychologist considered

reducing his social exchanges with the neighbor, but this proved infeasible. After

seeking consultation from a colleague, the psychologist decided that he could not ensure

therapeutic objectivity or effectiveness if the situation continued. He decided to explain

the situation to the patient, provide a referral, and assist the transition to a new therapist

during pretermination counseling (see also Standard 10.10, Terminating Therapy).

􀀵 A consulting psychologist developed a company’s sexual harassment policy. After the

policy was approved and implemented, the psychologist took on the position of counseling

employees experiencing sexual harassment. One of the psychologist’s clients

then filed a sexual harassment suit against the company. The psychologist was called

on by the defense to testify as an expert witness for the company’s sexual harassment

policy and by the plaintiff as a fact witness about the stress and anxiety observed during

counseling sessions. The psychologist (a) immediately disclosed to the company and

the employee the nature of the multiple relationship; (b) described to both the problems

that testifying might raise, including the limits of maintaining the confidentiality

of information acquired from either the consulting or counseling roles; and (c) ceased

providing sexual harassment counseling services for employees. Neither party agreed

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Chapter 6 Standards on Human Relations——115

3.06 Conflict of Interest

Psychologists refrain from taking on a professional role when personal, scientific, professional, legal,

financial, or other interests or relationships could reasonably be expected to (1) impair their objectivity,

competence, or effectiveness in performing their functions as psychologists or (2) expose the

person or organization with whom the professional relationship exists to harm or exploitation.

Psychologists strive to benefit from and establish relationships of trust with those with

whom they work through the exercise of professional and scientific judgments based on

their training and experience and established knowledge of the discipline (Principle A:

Beneficence and Nonmaleficence and Principle B: Fidelity and Responsibility).

Standard 3.06 prohibits psychologists from taking on a professional role when competing

professional, personal, financial, legal, or other interests or relationships could reasonably

be expected to impair their objectivity, competence, or ability to effectively

perform this role. Psychologists, especially those with prescription privileges, should

also be sensitive to the effect of gifts from pharmaceutical or others who might exert

influence on professional decisions (Gold & Applebaum, 2011). Examples of conflicts

of interest sufficient to compromise the psychologist’s judgments include the following:

􀀴 Irrespective of patients’ treatment needs, to save money, a psychologist reduced the

number of sessions for certain patients after he had exceeded his yearly compensation

under a capitated contract with an HMO (see the Hot Topic in Chapter 9, “Managing

the Ethics of Managed Care”).

􀀴 A member of a faculty-hiring committee refused to recuse herself from voting when a

friend applied for the position under the committee’s consideration.

􀀴 A psychologist in private practice agreed to be paid $1,000 for each patient he

referred for participation in a psychopharmaceutical treatment study.

􀀴 A research psychologist agreed to provide expert testimony on a contingent fee basis,

thereby compromising her role as advocate for the scientific data.

􀀴 A psychologist who had just purchased biofeedback equipment for his practice began

to overstate the effectiveness of biofeedback to his clients.

􀀴 A prescribing psychologist failed to disclose to patients her substantial financial

investment in the company that manufactured the medication the psychologist frequently

recommended.

􀀴 A psychologist used his professional website to recommend Internet mental health

services in which he had an undisclosed financial interest.

􀀴 A school psychologist agreed to conduct a record review for the educational placement

of the child of the president of a foundation that contributed heavily to the

private school that employed the psychologist.

to withdraw its request to the judge for the psychologist’s testimony. The psychologist

wrote a letter to the judge explaining the conflicting roles and asked to be recused from

testifying (see Hellkamp & Lewis, 1995, for further discussion of this type of dilemma).

HMO

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116——PART II ENFORCEABLE STANDARDS

Conflicts of interest can extend to financial or other gains that accrue to psychologists

indirectly through the effect of their decisions on the interests of their

family members:

􀀴 An educational psychologist encouraged a school system she was consulting to purchase

learning software from a company that employed her husband.

􀀴 An organizational psychologist was hired by a company to provide confidential support

and referral services for employees with substance abuse problems. The psychologist

would refer employees he counseled to a private mental health group

practice in which his wife was a member.

􀀴 A research psychologist on the board of a private foundation encouraged the foundation

to fund a colleague’s proposal from which he would be paid as a statistical

consultant.

􀀴 A psychologist accepted a position on the board of directors from a company for

which she was currently conducting an independent evaluation of employee

productivity.

􀀴 A psychologist took on a psychotherapy client who was a financial analyst at the

brokerage company the psychologist used for his personal investments.

􀀴 A psychologist serving on her university’s IRB gave in to pressure to approve a study

with ethically questionable procedures because it would bring a substantial amount

of funding dollars to the university.

􀀵 A school psychologist refused the district superintendent’s request that she conduct

training sessions for teachers at an overcrowded school that would result in the misapplication

of behavioral principles to keep students docile and quiet.

Psychologists also have a fiduciary responsibility to avoid actions that would create

public distrust in the integrity of psychological science and practice (Principle B:

Fidelity and Responsibility). Accordingly, Standard 3.06 also prohibits taking on a

role that would expose a person or organization with whom a psychologist already

works to harm or exploitation. For example:

Psychologists in administrative positions have a responsibility to resist explicit

or implicit pressure to bias decisions regarding the adequacy of research participant

or patient protections to meet the needs of the institution’s financial interests.

Organizational and consulting psychologists should be wary of situations in

which an employer may request the psychologist to assist with managerial directives

that may be ethically inappropriate and harmful to the wellbeing of employees

(Lefkowitz, 2012).

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Chapter 6 Standards on Human Relations——117

Conflicts of Interest in Forensic Practice

Psychologists seek to promote accuracy and truthfulness in their work (Principle C:

Integrity). Forensic psychologists hired to provide expert testimony based on forensic

assessment or research relevant to the legal decision need to be aware of potential

conflicts of interest that may impair their objectivity or lead them to distort

their testimony. For example, psychologists providing expert testimony should not

provide such services on the basis of contingent fees (fees adjusted to whether a case

is won or lost) since this can exert pressure on psychologists to intentionally or

unintentionally modify their reports or testimony in favor of the retaining party.

However, if a psychologist is serving as a consultant to a legal team and will not be

testifying in court, a contingency fee may not be unethical as long as it does not lead

psychologists to distort facts in giving their advice (Heilbrun, 2001). Psychologists

should also avoid charging higher fees for testimony since this may motivate writing

a report that is more likely to lead to a request to testify (Heilbrun, 2001). Bush

et al. (2006) suggest psychologists set fixed rates (which may be required in some

states) and bill an hourly rate consistent for all activities.

Forensic psychologists hired by the defense team must also avoid explicit or

subtle pressure to use more or less sensitive symptom validation measures to assess

the mental status of the defendant. Psychologists should not submit to pressure by

a legal team to modify a submitted report. Amendments to the original report may

be added to correct factual errors, and if a report is rewritten, the rationale for the

changes should be given within the report (Bush et al., 2006; Martelli, Bush, &

Sasler, 2003). Interested readers may also refer to the Chapter 8 Hot Topic on

“Avoiding False and Deceptive Statements in Scientific and Clinical Expert

Testimony.”

Corporate Funding and Conflicts of Interest

in Research, Teaching, and Practice

The APA Task Force on External Funding (http://www.apa.org/pubs/info/reports/

external-funding.aspx) provides a detailed history of conflicts of interest in related

fields and provides specific recommendations for psychology (see also Pachter, Fox,

Zimbardo, & Antonuccio, 2007). Recommendations include the following:

When research is industry sponsored, psychologists should ensure that they

have input into study design, independent access to raw data, and a role in

manuscript submission.

Full public disclosure regarding financial conflicts of interest should be

included in all public statements.

Psychologists should be aware and guard against potential biases inherent in

accepting sponsor-provided inducements that might affect their selection of

textbooks or assessment instruments.

Practitioners should be alert to the influence on clients/patients of sponsorprovided

materials (e.g., mugs, pens, notepads) that might suggest endorsement

of the sponsor’s products.

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118——PART II ENFORCEABLE STANDARDS

Many federal agencies, professional and scientific organizations, and academic

and other institutions have conflict of interest policies of which psychologists

should be aware.

The National Institutes of Health (NIH) Office of Extramural Research

requires every institution receiving Public Health Service (PHS) research

grants to have written guidelines for the avoidance and institutional review

of conflict of interest. These guidelines must reflect state and local laws and

cover financial interests, gifts, gratuities and favors, nepotism, political participation,

and bribery. In addition, employees accepting grants or contracts

are expected to be knowledgeable of the granting and contracting organization’s

conflict-of-interest policy and to abide by it (http://grants.nih.gov/

grants/policy/coi/). In addition, the PHS Regulations 42 CFR Part 50

(Subpart F) and 45 CFR Part 94 provide conflict-of-interest guidelines for

individual investigators (http://grants.nih.gov/grants/guide/notice-files/

not95-179.html).

The APA Editor’s Handbook: Operating Procedures and Policies for APA

Publications (APA, 2006, Policy 1.03) requires that journal reviewers and editors

avoid either real or apparent conflict of interest by declining to review

submitted manuscripts from recent collaborators, students, or members of

their institutions or work from which they might obtain financial gain. When

such potential conflicts of interest arise or when editors or associate editors

submit their own work to the journal they edit, the Handbook recommends

that the editor (a) request a well-qualified individual to serve as ad hoc Action

Editor, (b) set up a process that ensures the Action Editor’s independence, and

(c) identify the Action Editor in the publication of the article. APA also

requires all authors to submit a Full Disclosure of Interests Form that certifies

whether the psychologist or his or her immediate family members have significant

financial or product interests related to information provided in the

manuscript or other sources of negative or positive bias (www.apa.org/pubs/

authors/disclosure_of_interests.pdf).

The APA Committee on Accreditation’s Conflict of Interest Policy for Site

Visitors includes prohibitions against even the appearance of a conflict of

interest for committee members and faculty in the program being visited.

Possible conflicts include former employment or enrollment in the program

or a family connection or close friend or professional colleague in the program

(http://www.apa.org/ed/accreditation/visits/conflict.aspx).

The NASP’s Professional Conduct Manual requires psychologists to avoid conflicts

of interest by recognizing the importance of ethical standards and the

separation of roles and by taking full responsibility for protecting and informing

the consumer of all potential concerns (NASP, 2010, V.A.1).

According to the SGFP (AP-LS Committee on the Revision of the Specialty

Guidelines for Forensic Psychologists, 2010), psychologists should not provide

services to parties to a legal proceeding on the basis of a contingent fee

(SGFP, IV.B).

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Chapter 6 Standards on Human Relations——119

3.07 Third-Party Requests for Services

When psychologists agree to provide services to a person or entity at the request of a third party,

psychologists attempt to clarify at the outset of the service the nature of the relationship with all

individuals or organizations involved. This clarification includes the role of the psychologist (e.g.,

therapist, consultant, diagnostician, or expert witness), an identification of who is the client, the

probable uses of the services provided or the information obtained, and the fact that there may

be limits to confidentiality. (See also Standards 3.05, Multiple Relationships, and 4.02, Discussing

the Limits of Confidentiality.)

Psychologists are often asked to conduct an assessment, provide psychotherapy,

or testify in court by third parties who themselves will not be directly involved in

the evaluation, treatment, or testimony.

In all these cases, Standard 3.07 requires psychologists at the outset of services

to explain to both the third party and those individuals who will receive psychological

services the nature of the psychologist’s relationship with all individuals or

organizations involved. This includes providing information about the role of the

psychologist (i.e., therapist, consultant, diagnostician, expert witness), identifying

whether the third party or the individual receiving the services is the client, who

will receive information about the services, and probable uses of information

gained or services provided.

􀀵 A company asked a psychologist to conduct preemployment evaluations of potential

employees. The psychologist informed each applicant evaluated that she was working

for the company, that the company would receive the test results, and that the information

would be used in hiring decisions.

􀀵 A school district hired a psychologist to evaluate students for educational placement.

The psychologist first clarified state and federal laws on parental rights regarding

educational assessments, communicated this information to the school superintendent

and the child’s guardian(s), and explained the nature and use of the assessments

and the confidentiality and reporting procedures the psychologist would use.

􀀵 A legal guardian requested behavioral treatment for her 30-year-old developmentally

disabled adult child because of difficulties he was experiencing at the sheltered workshop

where he worked. At the outset of services, using language compatible with the

client’s/patient’s intellectual level, the psychologist informed the client/patient that

the guardian had requested the treatment, explained the purpose of the treatment,

and indicated the extent to which the guardian would have access to confidential

information and how such information might be used.

􀀵 A defense attorney hired a psychologist to conduct an independent evaluation of a

plaintiff who claimed that the attorney’s client had caused her emotional harm. The

plaintiff agreed to be evaluated. The psychologist first explained to the plaintiff that

the defense attorney was the client and that all information would be shared with the

attorney and possibly used by the attorney to refute the plaintiff’s allegations in court.

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120——PART II ENFORCEABLE STANDARDS

Legal Representatives Seeking to

Retain a Forensic Psychologist

In many instances, forensic psychologists will be retained by the attorney

representing the legal party’s interests. In such instances, the attorney is the psychologist’s

client. During the initial consultation with a legal representative seeking

the psychologist’s forensic services, psychologists should consider providing

the following information: (a) the fee structure for anticipated services; (b) previous

or current obligations, activities, or relationships that might be perceived as

conflicts of interest; (c) level and limitations of competence to provide forensic

services requested; and (d) any other information that might reasonably be

expected to influence the decision to contract with the psychologist (see AP-LS

Committee on the Revision of the Specialty Guidelines for Forensic Psychologists,

2010; Standard 6.04a, Fees and Financial Arrangements).

Implications of HIPAA

Psychologists planning to share information with third parties should also carefully

consider whether such information is included under the HIPAA definition of

Protected Health Information (PHI), whether HIPAA regulations require prior

patient authorization for such release, or whether the authorization requirement

can be waived by the legal prerogatives of the third party (45 CFR 164.508 and

164.512). Psychologists should then clarify beforehand to both the third party and

recipient of services the HIPAA requirements for the release of PHI (see also “A

Word About HIPAA” in the Preface of this book).

3.08 Exploitative Relationships

Psychologists do not exploit persons over whom they have supervisory, evaluative, or other

authority such as clients/patients, students, supervisees, research participants, and employees.

(See also Standards 3.05, Multiple Relationships; 6.04, Fees and Financial Arrangements; 6.05,

Barter With Clients/Patients; 7.07, Sexual Relationships With Students and Supervisees; 10.05,

Sexual Intimacies With Current Therapy Clients/Patients; 10.06, Sexual Intimacies With Relatives

Once the evaluation commenced, the psychologist avoided using techniques that

would encourage the plaintiff to respond to the psychologist as a psychotherapist

(Hess, 1998).

􀀵 A judge ordered a convicted sex offender to receive therapy as a condition of parole.

The psychologist assigned to provide the therapy explained to the parolee that all

information revealed during therapy would be provided to the court and might be

used to rescind parole.

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Chapter 6 Standards on Human Relations——121

or Significant Others of Current Therapy Clients/Patients; 10.07, Therapy With Former Sexual Partners;

and 10.08, Sexual Intimacies With Former Therapy Clients/Patients.)

Standard 3.08 prohibits psychologists from taking unfair advantage of or manipulating

for their own personal use or satisfaction students, supervisees, clients/

patients, research participants, employees, or others over whom they have authority.

The following are examples of actions that would violate this standard:

􀀴 Repeatedly requiring graduate assistants to work overtime without additional

compensation

􀀴 Requiring employees to run a psychologist’s personal errands

􀀴 Taking advantage of company billing loopholes to inflate rates for consulting services

􀀴 Encouraging expensive gifts from psychotherapy clients/patients

􀀴 Using “bait-and-switch” tactics to lure clients/patients into therapy with initial low

rates that are hiked after a few sessions

Violations of Standard 3.08 often occur in connection with other violations of

the Ethics Code. For example:

􀀴 Psychologists exploit the trust and vulnerability of individuals with whom they work

when they have sexual relationships with current clients/patients or students

(Standards 10.05, Sexual Intimacies With Current Therapy Clients/Patients, and 7.07,

Sexual Relationships With Students and Supervisees).

􀀴 Exploitation occurs when a psychologist accepts nonmonetary remuneration from

clients/patients, the value of which is substantially higher than the psychological services

rendered (Standard 6.05, Barter With Clients/Patients).

􀀴 Psychologists exploit patients with limited resources who they know will require longterm

treatment plans when they provide services until the patients’ money or insurance

runs out and then refer them to low-cost or free alternative treatments.

􀀴 It is exploitative to charge clients/patients for psychological assessments for

which the client/patient had not initially agreed to and that are unnecessary for

the agreed on goals of the psychological evaluation (Standard 6.04a, Fees and

Financial Arrangements).

􀀴 School psychologists exploit their students when, in their private practice, they provide

fee-for-service psychological testing to students who could receive these services

free of charge from the psychologist in the school district in which they work

(Standard 3.05a, Multiple Relationships; see also the Professional Conduct Manual

for School Psychology, National Association of School Psychologists, 2010, http://

www.nasponline.org/standards/ProfessionalCond.pdf).

Standard 3.08 does not prohibit psychologists from having a sliding-fee scale or

different payment plans for different types or amount of services, as long as the fee

practices are fairly and consistently applied.

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122——PART II ENFORCEABLE STANDARDS

Recruitment for Research Participation

Institutional populations are particularly susceptible to research exploitation.

Prisoners and youth held for brief periods in detention centers, for example, are

highly vulnerable because of their restricted autonomy and liberty, often compounded

by their low socioeconomic status, poor education, and poor health

(Gostin, 2007). Incarcerated persons have few expectations regarding privacy protections

and may view research participation as a means of seeking favor with or

avoiding punishment from prison guards or detention officials. Inpatients in psychiatric

centers or nursing homes are also vulnerable to exploitive recruitment practices

that touch upon their fears that a participation refusal will result in denial of other

needed services. Investigators should ensure through adequate informed consent

procedures and discussion with institutional staff that research participation is not

coerced (Fisher, 2004; Fisher et al., 2002; Fisher & Vacanti-Shova, 2012; see also

Standards 8.02, Informed Consent to Research, and 8.06, Offering Inducements for

Research Participation).

3.09 Cooperation With Other Professionals

When indicated and professionally appropriate, psychologists cooperate with other professionals

in order to serve their clients/patients effectively and appropriately. (See also Standard 4.05,

Disclosures.)

Individuals who come to psychologists for assessment, counseling, or therapy

are often either receiving or in need of collateral medical, legal, educational, or

social services. Collaboration and consultation with, and referral to, other professionals

are thus often necessary to serve the best interests of clients/patients.

Standard 3.09 requires psychologists to cooperate with other professionals when it

is appropriate and will help serve the client/patient most effectively. For example:

􀀵 With permission and written authorization of the parent, a clinical child psychologist

spoke with a child’s teacher to help determine if behaviors suggestive of attention

deficit disorder exhibited at home and in the psychologist’s office were consistent

with the child’s classroom behavior.

􀀵 With consent from the parent, a school psychologist contacted a social worker who

was helping a student’s family apply for public assistance to help determine the availability

of collateral services (e.g., substance abuse counseling).

􀀵 A psychologist with prescribing privileges referred a patient to a physician for diagnosis

of physical symptoms thought by the patient to be the result of a psychological

disorder that was more suggestive of a medical condition.

In schools, hospitals, social service agencies, and other multidisciplinary settings,

a psychologist may have joint responsibilities with other professionals for the

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Chapter 6 Standards on Human Relations——123

assessment or treatment of those with whom they work. In such settings, psychologists

should develop a clear agreement with the other professionals regarding overlapping

and distinct role responsibilities and how confidential information should

be handled in the best interests of the students or clients/patients. The nature of

these collaborative arrangements should be shared with the recipients of the services

or their legal guardians.

Implications of HIPAA

Psychologists who are covered entities under HIPAA should be familiar with

situations in which regulations requiring patients’ written authorization for

release of PHI apply to communications with other professionals (45 CFR 164.510,

164.512). They should also be aware of rules governing patients’ rights to know

when such disclosures have been made (45 CFR 164.520, Notice of Privacy

Practices, and 45 CFR 164.528, Accounting of Disclosures of Protected Health

Information).

3.10 Informed Consent

(a) When psychologists conduct research or provide assessment, therapy, counseling, or consulting

services in person or via electronic transmission or other forms of communication, they obtain

the informed consent of the individual or individuals using language that is reasonably understandable

to that person or persons except when conducting such activities without consent is

mandated by law or governmental regulation or as otherwise provided in this Ethics Code. (See

also Standards 8.02, Informed Consent to Research; 9.03, Informed Consent in Assessments; and

10.01, Informed Consent to Therapy.)

Informed consent is seen by many as the primary means of protecting the selfgoverning

and privacy rights of those with whom psychologists work (Principle E:

Respect for People’s Rights and Dignity). Required elements of informed consent for

specific areas of psychology are detailed in Standards 8.02, Informed Consent to

Research; 9.03, Informed Consent in Assessments; and 10.01, Informed Consent to

Therapy. The obligations described in Standard 3.10 apply to these other consent standards.

Language

In research, assessment, and therapy, psychologists must obtain informed consent

using language reasonably understandable by the person asked to consent. For

example, psychologists must use appropriate translations of consent information

for individuals for whom English is not a preferred language or who use sign language

or Braille. Psychologists should also adjust reading and language comprehension

levels of consent procedures to an individual’s developmental or educational

level or reading or learning disability.

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124——PART II ENFORCEABLE STANDARDS

Culture

Individuals from recently immigrated or disadvantaged cultural communities

may lack familiarity with assessment, treatment or research procedures, and

terminology typically used in informed consent documents (Fisher, in press).

These individuals may also be unfamiliar with or distrust statements associated

with voluntary choice and other client/patient or research participant rights

described during informed consent. Standard 3.10 requires sensitivity to the

cultural dimensions of individuals’ understanding of and anticipated responses

to consent information and tailor informed consent language to such dimensions.

This may also require psychologists to include educational components

regarding the nature of and individual rights in agreeing to psychological services

or research participation. For individuals not proficient in English, written

informed consent information must be translated in a manner that considers

cultural differences in health care or scientific concepts that present challenges

in a word-for-word translation. When using interpreters to conduct informed

consent procedures, psychologists must follow the requirements of Standard 2.05,

Delegation of Work to Others, in ensuring their competence, training, and

supervision. Readers may also wish to refer to Hot Topic “Multicultural Ethical

Competence” in Chapter 5.

Consent via Electronic Transmission

Standard 3.10a requires that informed consent be obtained when research,

assessment, or therapy is conducted via electronic transmission such as the telephone

or the Internet. Psychologists need to take special steps to identify the language

and reading level of those from whom they obtain consent via electronic

media. In addition, psychologists conducting work via e-mail or other electronic

communications should take precautions to ensure that the individual who gave

consent is in fact the individual participating in the research or receiving the psychologist’s

services (i.e., use of a participant/client/patient password).

Exemptions

Some activities are exempt from the requirements of Standard 3.10. For example,

psychologists conducting court-ordered assessments or evaluating military

personnel may be prevented from obtaining consent by law or governmental regulation.

In addition, several standards in the Ethics Code detail conditions under

which informed consent may be waived (Standards 8.03, Informed Consent for

Recording Voices and Images in Research; 8.05, Dispensing With Informed Consent

for Research; and 8.07, Deception in Research). HIPAA also permits certain exemptions

from patient authorization requirements relevant to research and practice,

which are discussed in later chapters on standards for research, assessment, and

therapy (see also “A Word About HIPAA” in the Preface of this book).

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Chapter 6 Standards on Human Relations——125

(b) For persons who are legally incapable of giving informed consent, psychologists nevertheless

(1) provide an appropriate explanation, (2) seek the individual’s assent, (3) consider such persons’

preferences and best interests, and (4) obtain appropriate permission from a legally authorized

person, if such substitute consent is permitted or required by law. When consent by a legally

authorized person is not permitted or required by law, psychologists take reasonable steps to

protect the individual’s rights and welfare.

Adults who have been declared legally incompetent and most children younger

than 18 years of age do not have the legal right to provide independent consent to

receive psychological services or participate in psychological research. In recognition

of these individuals’ rights as persons, Standard 3.10b requires that psychologists

obtain their affirmative agreement to participate in psychological activities after

providing them with an explanation of the nature and purpose of the activities and

their right to decline or withdraw from participation. The phrase “consider such

persons’ preferences and best interests” indicates that although in most instances,

psychologists respect a person’s right to dissent from participation in psychological

activities, this right can be superseded if failure to participate would deprive persons

of psychological services necessary to protect or promote their welfare.

For individuals who are legally incapable of giving informed consent, psychologists

must also obtain permission from a legally authorized person if such substitute

consent is permitted or required by law. Psychologists working with children

in the foster care system and in juvenile detention centers and those working with

institutionalized adults with identified cognitive or mental disorders leading to

decisional impairment must carefully determine who has legal responsibility for

substitute decision making. Psychologists should be aware that in some instances,

especially for children in foster care, legal guardianship may change over time.

Informed Consent in Research and Practice

Involving Children and Adolescents

In law and ethics, guardian permission is required to protect children from consent

vulnerabilities related to immature cognitive skills, lack of emotional preparedness

and experience in clinical or research settings, and actual or perceived

power differentials between children and adults (Fisher & Vacanti-Shova, 2012;

Koocher & Henderson Daniel, 2012). Despite these limitations, the landmark

“Convention on the Rights of the Child” (United Nations General Assembly, 1989)

established international recognition that children should have a voice in decisions

that affect their well-being. Out of respect for their developing autonomy, the APA

Ethics Code and federal regulations governing research (DHHS, 2009) require the

informed assent of children capable of providing assent. Psychologists working

with children should be familiar with the growing body of empirical data on the

development of children’s understanding of the nature of medical and mental

health treatment and research and with rights-related concepts such as confidentiality

and voluntary assent or dissent (Bruzzese & Fisher, 2003; Condie & Koocher, 2008;

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126——PART II ENFORCEABLE STANDARDS

D. Daniels & Jenkins, 2010; Field & Behrman, 2004; Fisher, 2002a; Gibson, Stasiulis,

Gutfreund, McDonald, & Dade, 2011; Koelch et al., 2009; V. A. Miller, Drotar, &

Kodish, 2004; Unguru, 2011).

Need to Know: Ethically Appropriate

Child and Adolescent Assent Procedures

When creating the content and language of ethically appropriate assent procedures, psychologists

should be guided by the following (Chenneville, Sibille, & Bendell-Estroff, 2010;

Fisher & Vacanti-Shova, 2012; Masty & Fisher, 2008):

Empirical literature on children’s understanding of the nature and purpose of

mental health treatment or research, confidentiality protections and limitations,

and the voluntary nature of participation (Standard 2.01, Boundaries of

Competence)

Scientific and clinical knowledge of the relationship between specific pediatric

mental health disorders and the cognitive and emotional capacity to assent

(Standard 2.04, Bases for Scientific and Professional Judgments)

Individual evaluation, when relevant, of the child’s appreciation of his or her

mental health status and treatment needs, understanding of the risks and benefits

of assent or dissent, the information he or she may want or need to make an

informed assent decision, and whether an assessment of assent capacity is

required

The child’s experience with his or her own health care decision making and preference

for the degree of involvement the child wishes to have in the treatment or

research participation decision

Children should never be asked to assent or dissent to participation if their choice

will not be respected, that is, in situations in which assessment or intervention is

necessary to identify or alleviate a mental health problem (see also the discussion

of assent to pediatric clinical trials in Chapter 11)

Emancipated and Mature Minors

There are instances when guardian permission for treatment or research is not

required or possible for children younger than 18 years of age. For example, emancipated

minor is a legal status conferred on persons who have not yet attained the

age of legal competency (as defined by state law) but are entitled to treatment as if

they have such status by virtue of assuming adult responsibilities, such as selfsupport,

marriage, or procreation. Mature minor is someone who has not reached

adulthood (as defined by state law) but who, according to state law, may be treated

as an adult for certain purposes (e.g., consenting to treatment for venereal disease,

drug abuse, or emotional disorders). Psychologists working with children need to

be familiar with the definition of emancipated and mature minors in the specific

states in which they work. When a child is an emancipated or mature minor,

informed consent procedures should follow Standard 3.10a.

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Chapter 6 Standards on Human Relations——127

Best Interests of the Child

The requirement for guardian permission may be inappropriate if there is serious

doubt whether the guardian’s interests adequately reflect the child’s interests

(e.g., cases of child abuse or neglect, genetic testing of a healthy child to assist in

understanding the disorder of a sibling) or cannot reasonably be obtained (e.g.,

treatment or research involving runaways). In such cases, the appointment of a

consent advocate can protect the child’s rights and welfare by verifying the minor’s

understanding of assent procedures, supporting the child’s preferences, ensuring

participation is voluntary, and monitoring reactions to psychological procedures.

Psychologists conducting research need to be familiar with federal regulations

regarding waiver of parental permission (45 CFR 46.408c) and have such waivers

approved by an IRB (Standard 8.01, Institutional Approval; Fisher, Hoagwood, &

Jensen, 1996; Fisher & Vacanti-Shova, 2012). Psychologists conducting therapy

need to be familiar with their state laws regarding provision of therapy to children

and adolescents without parental consent (Fisher, Hatashita-Wong, & Isman, 1999;

Koocher & Henderson Daniel, 2012).

Adults With Cognitive Impairments Who

Do Not Have Legal Guardians

There may be adults, such as those with Alzheimer’s disease or developmental

disabilities, who do not have a legal guardian but whose ability to fully understand

consent-relevant information is impaired (APA, 2012b). For example, clinical geropsychologists

frequently work with older persons with progressive dementia living

in nursing homes and assisted-living and residential care facilities where substitute

decision making is typically handled informally by family members or others. In

addition to obtaining consent from the individual, psychologists can seek additional

protections for the individual by encouraging a shared decision-making

process with or seeking additional permission from these informal caretakers

(Fisher, 1999, 2002b, 2003b; Fisher, Cea, Davidson, & Fried, 2006; see also the Hot

Topic, “Goodness-of-Fit Ethics for Informed Consent Involving Adults With

Impaired Decisional Capacity,” at the end of this chapter).

HIPAA Notice of Privacy Practices

HIPAA requires that if, under applicable law, a person has authority to act on

behalf of an individual who is an adult or minor in making decisions related to

health care, a covered entity must treat such a person (called a personal representative)

as the individual. Exceptions are permitted if there is reason to believe that the

patient has been abused or is endangered by the personal representative or that

treating the individual as a personal representative would not be in the best interests

of the client/patient (45 CFR 164.502g). This requirement refers to courtappointed

guardians or holders of relevant power of attorney of adults with

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128——PART II ENFORCEABLE STANDARDS

impaired capacities, parents who are generally recognized as personal representatives

of their minor children, and individuals designated as a representative by the

patient. To comply with both Standard 3.10b and the HIPAA Notice of Privacy

Practices (see “A Word About HIPAA” in the Preface of this book), psychologists

should provide the Notice of Privacy Practices to both the individual’s legal guardian

or personal representative and the client/patient.

(c) When psychological services are court ordered or otherwise mandated, psychologists inform

the individual of the nature of the anticipated services, including whether the services are court

ordered or mandated and any limits of confidentiality, before proceeding.

When informed consent is prohibited by law or other governing authority, psychologists

must nonetheless respect an individual’s right to know the nature of

anticipated services, whether the services were court ordered or mandated by

another governing authority, and the limits of confidentiality before proceeding.

Military Psychologists

When regulations permit, military psychologists should inform active-duty personnel

of the psychologist’s duty to report information revealed during assessment

or therapy to appropriate military agencies violations of the Uniform Code of

Military Justice.

Court-Ordered Assessments

Psychologists conducting a court-ordered forensic assessment must inform the

individual tested (a) why the assessment is being conducted, (b) that the findings

may be entered into evidence in court, and (c) if known to the psychologist, the

extent to which the individual and his or her attorney will have access to the information.

The psychologist should not assume the role of legal adviser but can advise

the individual to speak with his or her attorney when a testee asks about potential

legal consequences of noncooperation.

(d) Psychologists appropriately document written or oral consent, permission, and assent. (See

also Standards 8.02, Informed Consent to Research; 9.03, Informed Consent in Assessments; and

10.01, Informed Consent to Therapy.)

Standard 3.10d requires psychologists conducting research or providing health

or forensic services to document that they have obtained consent or assent from an

individual and permission by a legal guardian or substitute decision maker. In most

instances, individuals will sign a consent, assent, or permission form. Sometimes,

oral consent is appropriate, such as when obtaining a young child’s assent, when

working with illiterate populations, when there is concern that confidentiality may

be at risk (i.e., in war-torn countries where consent documents may be confiscated

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Chapter 6 Standards on Human Relations——129

by local authorities), or when a signature would risk identification in anonymous

surveys. In these situations, documentation can be provided by a note in the psychologist’s

records, or, in the case of anonymous, web-based or mail surveys, by the

participants’ checking a box to indicate that they have read the consent information

and agree to participate.

Implications of HIPAA

Appropriate documentation can also be related to legal requirements. For

example, HIPAA requires that all valid client/patient authorizations for the use and

disclosure of PHI be signed and dated by the individual or the individual’s personal

representative (45 CFR 164.508[c][1][vi]).

3.11 Psychological Services Delivered

To or Through Organizations

(a) Psychologists delivering services to or through organizations provide information beforehand

to clients and when appropriate those directly affected by the services about (1) the nature and

objectives of the services, (2) the intended recipients, (3) which of the individuals are clients,

(4) the relationship the psychologist will have with each person and the organization, (5) the

probable uses of services provided and information obtained, (6) who will have access to the

information, and (7) limits of confidentiality. As soon as feasible, they provide information about

the results and conclusions of such services to appropriate persons.

The informed consent procedures described in Standard 3.10, Informed Consent,

are often not appropriate or sufficient for consulting, program evaluation, job effectiveness,

or other psychological services delivered to or through organizations. In

such contexts, Standard 3.11 requires that organizational clients, employees, staff, or

others who may be involved in the psychologists’ activities be provided information

about (a) the nature, objectives, and intended recipients of the services; (b) which

individuals are clients and the relationship the psychologist will have with those

involved; (c) the probable uses of and who will have access to information gained;

and (d) the limits of confidentiality. Psychologists must provide results and conclusions

of the services to appropriate persons as early as is feasible.

􀀵 An industrial–organizational psychologist was hired to evaluate whether a company’s

flexible-shift policy had lowered employee absentee rates. In addition to a review of

employee records, the evaluation would include interviews with supervisors and employees

on the value and limits of the policy. The psychologist prepared a document for all

supervisors and employees explaining (a) the purpose of the evaluation, (b) the nature of

and reason for employee record review and the interviews, (c) that the evaluation would

be used to help the company decide if it should maintain or modify its current flexible-shift

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130——PART II ENFORCEABLE STANDARDS

(b) If psychologists will be precluded by law or by organizational roles from providing such information

to particular individuals or groups, they so inform those individuals or groups at the outset of the service.

Standard 3.11b pertains to situations in which psychological services not requiring

informed consent are mandated by law or governmental regulations, and the law or

regulations restrict those affected by the services from receiving any aspect of the

information listed in Standard 3.11a.

policy, (d) that no one in the company would have access to the identities of the individuals

interviewed, and (e) that the results and conclusions would be presented to the

company’s board of directors in a manner that protected confidentiality.

􀀵 A psychologist was hired by a school district to observe teacher management of student

behavior during lunch and recess to help the district determine how many teachers were

required for such activities and whether additional staff training was needed for these

responsibilities. The psychologist held a meeting for all teaching staff who would be

involved in the observations. At the meeting, the psychologist explained why the school

district was conducting the research, how long it would last, the ways in which notes and

summaries of observations would be written to protect the identities of individual teachers,

that a detailed summary of findings would be presented to the school superintendent,

and that, with the district’s permission, teachers would receive a summary report.

􀀵 A psychologist providing court-ordered therapy to a convicted pedophile submitted a

report to the court regarding the therapy client’s attendance and responsiveness to treatment.

The therapist was prohibited from releasing the report to the client. At the beginning

of therapy, the psychologist had informed the client that such a report would be

written and that the client would not have access to the report through the psychologist.

􀀵 A company stipulated that the results of a personality inventory conducted as part of an

employee application and screening process would not be available to applicants.

Psychologists informed applicants about these restrictions prior to administering the tests.

􀀵 An inmate of a correctional institution was required to see the staff psychologist after

repeatedly engaging in disruptive and violent behaviors that were jeopardizing the

safety of the staff and other prisoners. The psychologist explained to the inmate that

in this situation, she was acting on the request of prison officials to help the inmate

control his behaviors. She also informed the inmate that she would be submitting

formal reports on the sessions that might be used by prison officials to determine if

the inmate would be assigned to a more restrictive facility.

Implications of HIPAA

Standard 3.11b may also apply to health care settings in which institutional

policy dictates that testing results are sent to another professional responsible for

interpreting and communicating the results to the client/patient. However, the

nature of such institutional policies may be changing in light of HIPAA regulations

providing greater client/patient access to PHI and control of disclosures of PHI.

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Chapter 6 Standards on Human Relations——131

3.12 Interruption of Psychological Services

Unless otherwise covered by contract, psychologists make reasonable efforts to plan for facilitating

services in the event that psychological services are interrupted by factors such as the psychologist’s

illness, death, unavailability, relocation, or retirement or by the client’s/patient’s

relocation or financial limitations. (See also Standard 6.02c, Maintenance, Dissemination, and

Disposal of Confidential Records of Professional and Scientific Work.)

Planned and unplanned interruptions of psychological services often occur. For

example, a psychologist can leave a job at a mental health care facility for a new

position, take parental or family leave, interrupt services for a planned medical

procedure, or retire from private practice. Clients/patients may move out of state or

have a limited number of sessions covered by insurance.

When interruption of services can be anticipated, Standard 3.12 requires psychologists

to make reasonable efforts to ensure that needed service is continued. Such efforts

can include (a) discussing the interruption of services with the clients/patients and

responding to their concerns, (b) conducting pretermination counseling, (c)referring

the client/patient to another mental health practitioner, and, if feasible and clinically

appropriate, (d) working with the professional who will be responsible for the client’s/

patient’s case (see also Standard 10.10, Terminating Therapy).

􀀵 A psychologist providing Internet-mediated psychological services to clients in a distant

rural community included in her informed consent information the address of a

website she created providing continuously updated information on the names, credentials,

and contact information of local and electronically accessible backup professionals

available to assist clients if the psychologist was not immediately available

during an emergency.

Standard 3.12 also requires psychologists to prepare for unplanned interruptions

such as sudden illness or death. In most cases, it would suffice to have a

trusted professional colleague prepared to contact clients/patients if such a

situation arises. Pope and Vasquez (2007) recommend that psychologists create

a professional will, including directives on the person designated to assume

primary responsibility, backup personnel, coordinated planning, office security

and access, easy to locate schedule, avenues of communication, client records

and contact information, client notification, colleague notification, professional

liability coverage, attorney for professional issues, and billing records

and procedures.

The phrase “reasonable efforts” reflects awareness that some events are unpredictable

and even the best-laid plans may not be adequate when services are interrupted.

The phrase “unless otherwise covered by contract” recognizes that there may be

some instances when psychologists are prohibited by contract with a commercial or

health care organization from following through on plans to facilitate services.

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HOT TOPIC

Goodness-of-Fit Ethics for Informed Consent

to Research and Treatment Involving Adults

With Impaired Decisional Capacity

An outgrowth of the person-centered care movement has been growing recognition that adults with cognitive

disorders have rights, including the right to make decisions related to their own health care, independent living,

financial management, and participation in research (McKeown, Clarke, Ingleton, & Repper, 2010). The process of

obtaining informed consent presents unique ethical challenges for mental health treatment and research involving

adults with schizophrenia, developmental disabilities, Alzheimer’s disease, and other disorders characterized

by fluctuating, declining, or long-term impairments in decisional capacity. The heterogeneity of cognitive strengths

and deficits within each of these diagnostic groups means that judgments about each individual’s decisional

capacity cannot be based solely on his or her diagnosis (Kaup, Dunn, Saks, Jeste, & Palmer, 2011; Pierce, 2010).

Obtaining informed consent from these populations raises a fundamental ethical question: How can psychologists

balance their ethical obligation to respect the dignity and autonomy of persons with mental disorders to make

their own decisions with the obligation to ensure that ill-informed or incompetent choices do not jeopardize their

welfare or leave them open to exploitation (Fisher, 1999)?

Legal Status, Diagnostic Labels, and Consent Capacity

Some adults with serious mental disorders have been declared legally incompetent to consent. Removal of a

person’s legal status as a consenting adult does not, however, deprive him or her of the moral right to be

involved in treatment or research participation decisions. For these adults, APA Ethics Code Standard 3.10b

requires that psychologists obtain the appropriate permission from a legally authorized person and provide an

appropriate explanation to the prospective client/patient or research participant, consider such person’s preferences

and best interests, and seek the individual’s assent.

The implementation of ethically appropriate consent procedures is more complex for the many situations

in which individuals diagnosed with neurological or other mental health disorders retain the legal status of a

consenting adult, though their capacity for making informed, rational, and voluntary decisions may be compromised.

Each person with a serious mental disorder is unique. Sole reliance on a diagnostic label to determine

a client’s/patient’s capacity to make treatment or research participation decisions risks depriving persons

with mental disorders of equal opportunities for autonomous choice.

Fitting Consent Procedures

to Enhance Decisional Capacities and Protections

Thomas Grisso and Paul Appelbaum (Appelbaum & Grisso, 2001; Grisso & Appelbaum, 1998) have developed

the most well-known model of consent capacity for clinical research and treatment. Based on a psycho-legal

perspective, it consists of four increasingly complex consent components: choice, understanding, appreciation,

and reasoning. This model has given rise to several empirically validated instruments (Dunn, Nowrangi, Palmer,

Jeste, & Saks, 2006). However, in the case of Alzheimer’s Disease for example, practitioners do not agree on

the salience of these components for deciding a client’s/patient’s consent capacity (Volicer & Ganzine, 2003).

From an ethical perspective, assessing capacity is a necessary but insufficient basis for determining whether

an individual should be granted or deprived of the right to autonomously consent to treatment, assessment,

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Chapter 6 Standards on Human Relations——133

or research. In her Goodness-of-Fit Ethics (GFE) for informed consent, Fisher argues that the burden of consent

capacity must be shared by psychologists and the individuals from whom consent is sought (Fisher, 2002a,

2002b, 2003). According to GFE, just and respectful informed consent processes require psychologists not only

to identify the consent strengths and vulnerabilities of the specific individuals or groups with whom they will

work, but also to take responsibility to create consent procedures that can minimize vulnerabilities, enhance

consent strengths, and provide consent supports when feasible (Fisher, 2005b; Fisher & Masty, 2006; Fisher &

Ragsdale, 2006; Fisher & Vacanti-Shova, 2012).

Goodness-of-Fit and Components of Consent

This section describes the four components of Grisso and Appelbaum’s model and discusses how the informed

consent process can be enhanced through goodness-of-fit procedures.

Choice

Evidencing a choice reflects the ability to actively indicate consent or dissent. For example, some adults

suffering from catatonia or Parkinson’s dementia may be unable to communicate a choice verbally or nonverbally.

While these individuals may understand some of the consent information presented and may have a

participation preference, their inability to communicate agreement or dissent will require stringent safeguards

against harmful or exploitative consent procedures.

In such settings, creating a goodness of fit between person and consent context often requires respectful

inclusion of a consent surrogate who has familiarity with the patient’s preference history. The proxy can help

ensure that the consent decision reflects, to the extent feasible, the patient’s attitudes, hopes, and concerns.

Once proxy consent has been obtained, respect for personhood and protection of individual welfare requires

psychologists to be alert to patient expressions of anxiety, fatigue, or distress that indicate an individual’s dissent

or desire to withdraw from participation.

Understanding

Understanding reflects comprehension of factual information about the nature, risks, and benefits of treatment

or research. When understanding is hampered by problems of attention or retention, psychologists can

incorporate consent enhancement techniques into their procedures such as incorporating pictorial representations

of treatment or research procedures, presenting information in brief segments, or using repetition. Person–

consent context fit also requires identifying which information is and is not critical to helping an individual

make an informed choice. For example, when seeking consent for a behavioral intervention for aggressive

disorders in a residence for adults with developmental disabilities, it may be important for clients to understand

the specific types of behaviors targeted (e.g., hitting other residents), the reward system that will be used

(e.g., points toward going to movies or other special activities), and who will be responsible for monitoring the

behavior, for example, residential staff (Cea & Fisher, 2003; Fisher et al., 2006). Although individuals should be

informed about the confidentiality and privacy of their records, psychologists should consider whether it is

important to limit the right to make autonomous decisions to only those individuals who understand details

of residential policies regarding the protection of residents’ health records, especially if the confidentiality

protections do not differ from those that are a natural and ongoing part of the residential experience.

Appreciation

Appreciation refers to the capacity to comprehend the personal consequences of consenting or dissenting

to treatment or research. For example, an adult with a dual diagnosis may understand that treatment will require

limiting aggressive behavior but not appreciate the difficulties he or she may have in adhering to the behavioral

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134——PART II ENFORCEABLE STANDARDS

rules. An individual suffering from schizophrenia may understand that clinical research is testing treatment

effectiveness but may not appreciate that he or she has a disorder that requires treatment.

A sliding-scale approach based on the seriousness of personal consequences of the consent decision can

be helpful in evaluating the ethical weight that should be given to the client’s/patient’s or prospective research

participant’s capacity for appreciation. For example, understanding may be sufficient for consent decisions to

standard or experimental interventions that present minimal risk and are supplemental to current treatment

programs. On the other hand, appreciation may be essential when the treatment or experimental intervention

may expose the individual to the risk of serious side effects or offer an opportunity to receive needed services

not otherwise available.

Reasoning

Reasoning reflects the ability to weigh the risks and benefits of consent or dissent. For example, an adult

with schizophrenia with paranoid features may understand the nature of a treatment and appreciate its potential

for reducing his anxiety but may reason that the risks outweigh the potential benefits because the psychologist

offering the treatment is part of a government conspiracy to undermine his freedom. There is also

preliminary evidence that severe empathic deficits may confound reasoning about research participation even

when other cognitive skills are preserved (Supady, Voelkel, Witzel, Gubka, & Northoff, 2011). At the same time,

psychologists should be cautious about the legal consequences of erroneously assuming that paper-and-pencil

assessments of reasoning associated with decisional capacity are sufficient to evaluate “performative capacity”

defined as the ability of individuals to perform particular tasks (Appelbaum, 2009).

Asking individuals with questionable reasoning capacity to select a family member, friend, or other trusted

person to be present during an informed consent discussion can be empowering and avoid the risk of triggering a

legal competency review solely for the purposes of a single mental health treatment or research participation decision

(Fisher, 2002a; Fisher et al., 2006; Roeher Institute, 1996).

Consent and Empowerment

People with long-standing, declining, or transient disorders related to decisional capacities may be accustomed

to other people making decisions for them and may not understand or have experience applying the concept

of autonomy. In institutional contexts, individuals with mental disorders may fear disapproval from doctors or

residence supervisors or feel that they must be compliant in deference to the authority of the requesting psychologist.

Some may have little experience in exercising their rights or, if they are living in a community residence,

may be fearful of discontinuation of other services. Baeroe (2010) has described current approaches to

competency evaluations and surrogate consent in health care settings as arbitrary and inconsistently applied.

She questions whether the capacity decision of a single practitioner and the health care decision of a single

guardian are sufficient means of respecting patient autonomy, particularly for individuals with borderline

decision-making capacity. While recognizing the potential strain on institutional resources, she recommends a

“collective deliberation” for hospitalized patients with ambiguous capacity that would include the patient, his

or her guardian, health care workers with specific knowledge about the patient, and patient advocates.

To empower and respect the autonomy of patients or prospective research participants, psychologists can

study the nature of consent misconception among diagnostic groups and use this knowledge to develop brief

interventions to enhance consent capacity (Cea & Fisher, 2003; Fisher et al., 2006; Kaup et al., 2011; Mittal et al.,

2007). Modifying the consent setting to reduce the perception of power inequities, providing opportunities to

practice decision making, demonstrating that other services will not be compromised, and drawing on the

support of trusted family members and peers can strengthen the goodness of fit between person and consent

setting and ensure that informed consent is obtained within a context of justice and care

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PSY week 2 rewriting work

July 1, 2025/in Psychology Questions /by Besttutor

Respond to the following questions in 200-250

§ What makes the psychoanalytic-social perspective of personality unique?

§ What are the main components of each of the psychoanalytic-social personality theories? What are some of the main differences between theories?

§ Choose one of the psychoanalytic-social personality theories, and apply it to your own life. Explain your own personality and personality development through this theory.

Psychoanalytic-Social Personality Perspective

Running head: PSYCHOANALYTIC-SOCIAL PERSONALITY PERSPECTIVE

1

 

 

PSYCHOANALYTIC-SOCIAL PERSONALITY PERSPECTIVE

5

 

 

 

Psychoanalytic-Social Personality Perspective

What makes the psychoanalytic-social perspective of personality unique?

Our personality is who we are, who we become. Personality is a major interest within study of psychology because it can be used to better understand who people are. It helps us understand why people react differently in same situations, as well as the consistency of their responses. A simple breakdown shows that the Psychoanalytic social theory was created upon the theory that cultural and social conditions, particularly the various experiences one would have during their childhood, play a big role in shaping a person’s personality. Those who did not have their needs for love and affection fulfilled during their childhood develop some sort of aggression toward their parents, because of this aggression they could develop some level of anxiety. It could be an understood culture that is not controlled by any sort of cultural values, but this could be a hard task to complete. “Erikson envisioned a psychoanalytic approach that would consider social and cultural realities rather than focusing exclusively on the individual, as Freud had done. James Cote and Charles Levine have developed such a psychoanalytic social psychology in their research and theorizing” (Cloninger, 2013).

What are the main components of each of the psychoanalytic-social personality theories? What are some of the main differences between theories?

The psychoanalytic-social personality theories are composed of the individual psychological theory, psychosocial development, and interpersonal psychoanalytic theory. In the individual psychological theory, Alder proposed that people should be characterized by a social perspective, and not biological. In other words, Alder argued that we should focus on a person’s individual goals and how it shapes an individual. Adler’s inferiority complex is a concept that a person is overcome with a feeling of lack of self-worth. This suggest that each person has a felt minus, since all people began life as a newborn, inferior to others and relying on the needs of others for their survival. Any short comings may encourage an individual to excel further to achieve their desire outcome the “aggressive drive”. Likewise, Erikson’s psychosocial development theory argues that a person develops based on its culture or society. The main components of this theory are the psychosocial stages which incorporate culture starting from infancy. Erikson further explains his theory with the epigenetic principle, which states that psychosocial development based on a biological model. Karen Horney’s psychoanalytic-social personality theory’s main components consist of neurosis and psychoanalysis involving inner conflicts. Langenderfer (1999), “The personality she gave is an example of children and how parents as well as other socializing factors influence their personality. For instance, a normal child goes through life having certain characteristics of themselves when relating experiences with school, hobbies, and home. However, when looking at a child that is neurotic the environmental factors isolates their true self.” Horney believes that Freud’s theory about sexuality and continuous compulsives, is interfering with an individual, the family, and social factors where there is organization of values, and attitudes. Freud believes they are compulsive drives from nature, involving every human being. She believes they are compulsive drives but become neurotic by a human feeling isolated, helpless, afraid, and hostile.

Choose one of the psychoanalytic-social personality theories, and apply it to your own life. Explain your own personality and personality development through this theory.

Erikson’s eight stages of the life cycle is the most intriguing to myself. McLeod (2013), “According to Erikson, the ego develops as it successfully resolves crises that are distinctly social in nature. These involve establishing a sense of trust in others, developing a sense of identity in society, and helping the next generation prepare for the future”. As you progress through the life cycle, you encounter different events that influence your personality over time. Completing a stage successfully results in a healthy personality. Whereas failure to complete a stage results in a reduced ability to complete the future stages. Growing up my parents set expectations for me based off my age. Every life lesson I was taught was so that I would be able to successfully make it to the next life cycle. Because of the guidance I received from my parents, I didn’t encounter all of the crisis described in Erikson’s life cycles. The next life cycle for myself is Generativity vs Stagnation. I can achieve the virtue of care by giving back to society, being productive at work, and becoming involved in the community. From the experiences of my past, I can create a wonderful future with a healthy personality.

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Cloninger, S. C. (2013). Theories of Personality: Understand Persons (6th ed.). : .

Langenderfer, G. (1999). Karen Horney. Retrieved from http://muskingum.edu/~psych/psycweb/history/horney.htm

McLeod, S. (2013). Erik Erikson. Retrieved from http://www.simplypsychology.org/Erik-Erikson.html

 

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Complete the Strategic section in the “Model Matrix” worksheet.

July 1, 2025/in Psychology Questions /by Besttutor

cid:D7D4B297-EEAE-4174-AD01-F87097282051@canyon.com

PCN-518 Topic 4: The Six Stages of Kohlberg

 

Scenario:

A female adolescent’s parents place a low priority on the value of an education. In fact, they prefer that she care for younger siblings instead of studying or completing a high school education. It is March. The student has told her parents that she has in-school suspension for the rest of the school year in order to have time to study, as she dreams of attending college one day.

 

Directions: Read the scenario listed above. Complete all sections of the matrix provided below from the perspective of an individual in each of the six stages of Kohlberg’s theory of moral development and the information from the provided scenario. Use complete sentences and include proper scholarly citations for any sources used.

 

Level 1: Preconventional Morality

Stage Adolescent’s Perspective Rationale for your Responses
 

Stage 1: Obedience and Punishment Orientation

 

The adolescent should take care of her younger siblings because her parents want her to do so. A child assumes that those with authority hand down a set of rules which the child must obey unquestionably. In this case, the adolescent must unquestionably obey her parents’ desire for her to quit school to take care of her siblings (Gibbs, 2013).

 

 

 

Stage 2: Instrumental Relativist Orientation/Exchange of Favors

 

The child can go to the in-school suspension to improve her chances of going to college one day, or obey her parents and stay at home to take care of her siblings. The child recognizes that there is no single right view handled down by authorities and different individuals have different opinions. Everyone is free to pursue his/her own personal interests because everything is relative (Gibbs, 2013).
 
 

Stage 3: Conventional Level/Good Boy or Girl

 

The adolescent should live up to her parents’ expectations of her taking care of her siblings. She should exhibit good intentions to her siblings by taking care of them.

 

Goswami (2008) argues that children see morality as being more complex; people should conform to the expectations of their family and community and be good mannered. People should exhibit good behavior by having good feelings and motives such as empathy, love trust as well as concern for others.

 

 

Stage 4: Maintaining the Social Order

 

Should go to the in-school program to enhance her knowledge. In this stage, the respondent is more concerned with the society in its entirety. They emphasize on respecting authority, obeying laws and performing one’s duties to maintain the social order. One should not break the law whenever he/she feels they have a good reason (Gibbs, 2013).

 

 
 

Stage 5: Social Contract and Individual Rights

 

Adolescent should continue with her studies as it is her right to get basic education Respondents believe that a good society is based on a social contract which they freely enter. They argue that basic rights should be protected (Goswami, 2008).
 

Stage 6: Universal Principles

 

Adolescent should go to school as getting an education is a protected right. According to Gibbs (2013), Respondents in this stage almost consider the society as good. They believe people need to protect certain individual rights, and settle disputes democratically.

 

 

 

 

 

References

Gibbs, J. C. (2013). Moral development and reality: Beyond the theories of Kohlberg, Hoffman, and Haidt. Oxford University Press.

Goswami, U. (Ed.). (2008). Blackwell handbook of childhood cognitive development. John Wiley & Sons.

© 2017. Grand Canyon University. All Rights Reserved.

© 2017. Grand Canyon University. All Rights Reserved.

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APA Format for a needs assessment paper

July 1, 2025/in Psychology Questions /by Besttutor

MILT 375

 

APA Format Paper Instructions

 

This assignment will prepare you for developing well-written and formatted papers for this course, and others in which you use APA formatting. The paper is to be 4 pages that demonstrate your ability and understanding of APA format and writing style.

 

The paper will consist of:

 

1. A Title/Cover Page: This page of the assignment will have your running head and page number, your title of the assignment, your name, and specific information necessary for any APA research paper. Make sure this page and every page is formatted with correct spacing, content positioning, type font, size of font, etc.

 

2. Abstract Page: Write this abstract as the one you would write for your Needs Assessment paper. It is very important that you read the APA manual to understand what an abstract is supposed to be. Make sure it is in the correct tense and correct format. You will not be able to give your reader your final findings as indicated in number 3 in the instructions for the Needs Assessment paper, yet you can write the rest of the abstract with a fair amount of accuracy. Remember, this paper is an “exercise” to get a head start, demonstrate your ability to develop a good APA formatted paper, and receive feedback on this before you submit the other 2 writing assignments for the course.

 

3. Paper Body Page: This page will consist of 2 basic components. The first will be a brief introduction paragraph. Introduce the Needs Assessment Paper. Even though you have not done a lot of reading or research yet, this should be fairly easy to do. The second component is a correctly formatted demonstration of all 5 APA level headings. You will need to use each heading with a single sentence telling your instructor which level it is. See the example of the first heading below.

 

Level 1 heading

 

A level 1 heading is bold face font, centered and uses upper and lower case font.

 

4. Reference Page: Use your page 4 to demonstrate your ability to cite references correctly. You will need to format the page while citing a website/internet article, a research article, book, the Bible, and an eBook. Use care to make sure all spacing, capitals, abbreviations, etc. are done according to APA.

 

Submit this assignment by 11:59 p.m. (ET) on Monday of Module/Week 3.

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Movie Worksheet

July 1, 2025/in Psychology Questions /by Besttutor

INTRODUCTION to “AWAKENINGS”

from www.filmeducaton.org/pdf/film/awakenings.pdf

 

In the winter of 1916-1917, an epidemic of a rare disease occurred, springing up, as virus

diseases sometimes do, seemingly out of nowhere. It spread over Europe and then to other

parts of the world and affected some five million people. The onset of the disease was sudden

and took different forms. Some people developed acute restlessness or insomnia or

dementia. Others fell into a trance-like sleep or coma. These different forms were recognised

and identified by the physician Constantin von Economo as one disease, which he called

encephalitis lethargica, or sleepy sickness.

 

Many people died of the disease. Of those who survived, some recovered completely. The

majority remained partly disabled, prone to symptoms reminiscent of Parkinson’s disease.

The worst affected sank into a kind of ‘sleep’, unable to move or speak, without any will of

their own, or hope, but conscious and with their memories intact. They were placed in

hospitals or asylums. Ten years after the epidemic had begun, it just as remarkably

disappeared. Fifty years later, the epidemic had been forgotten.

 

In 1966, when Dr. Oliver Sacks, a neurologist trained in London, took up his post at Mount

Carmel, a hospital in New York, he found there a group of eighty people who were the

forgotten survivors of the forgotten epidemic. It was clear that hundreds of thousands had

died in institutions. Dr. Sacks called them ‘the lepers of the present century’. In his book,

‘Awakenings’, he tells of his attempts to understand the nature of their affliction, but also of his

growing appreciation of them as individuals, with their own unique histories and experience.

 

In 1969, Dr. Sacks tried out a remarkable new drug, L-DOPA. For some of his patients, there

then followed a rapid and brief return to something like normality. They were suddenly

restored to the world of the late nineteen sixties. His book documents this remarkable

awakening, as experienced by twenty of his patients. L-DOPA was not, however, the magic

cure that it first seemed. The normality that it promoted soon broke down, with patients

subject to all kinds of bizarre behaviours.

 

In the film of ‘Awakenings’, Robert de Niro plays Leonard Lowe, someone affected by sleepy

sickness as a young man. He is in a state of near sleep, unable to move or speak. Every day,

his mother comes into hospital to care for him, as she has for many years. Robin Williams

plays Dr. Malcolm Sayer, the neurologist who, like Dr. Sacks himself in 1966, takes up a post

at a New York hospital, discovering there the forgotten survivors of the sleepy sickness

epidemic. He finds himself drawn to this group of chronically disabled people, and especially

to Leonard.

 

Robert de Niro’s Leonard is based on the Leonard L. who Sacks describes in his book – an

intelligent and courageous man with a wry sense of humour, who is able only to communicate

in a very limited way, using a letter board. Sacks says how thoroughly De Niro

prepared himself for his role, spending a great deal of time with post-encephalitic patients in

an effort to understand something of how it feels to be so chronically disabled, and to

represent as accurately as possible the quality of if disablement.

 

In the film, we are shown Leonard’s awakening under L-DOPA. Leonard sees the world to

which he has awoken truly wonderful. He has lost many years of his life. Now he wants to

live. He wants his independence. Briefly, we see him determined to achieve this before his

damaged nervous system pulls him back into a catatonic state.

 

 

In the book ‘Awakenings’, Dr. Sacks writes that Leonard says to him after the last futile trial of

another drug:

“Now I accept the whole situation. It was wonderful, terrible, dramatic and comic. It is finally –

sad, and that’s all there is to it. I’ve learned a great deal in the last three years. I’ve broken

through barriers which I had all life. And now, I’ll stay myself and you can keep your L-DOPA.”

 

A note about sleepy sickness:

Encephalitis lethargica (sleepy sickness, or sleeping sickness, as it is called in the U.S.A.) is

caused by a virus attacks the brain. In particular, it attacks a part of the mid-brain – the

substantia nigra – damaging the nerve cells this area and severely reducing their ability to

produce the chemical nerve impulse transmitter, dopamine. In respect, the disease is similar

to Parkinson’s disease. The cerebral cortex (the part of the brain concerned with conscious

awareness, thought and memory) is unaffected. When in the early 1960’s a substance (LDOPA) closely related to dopamine was found to alleviate the symptoms of Parkinson’s

disease, there was the hope that it would do the same for post-encephalitic patients, that is,

people suffering from the after-effects of sleepy sickness. In event, the effect of L-DOPA on

such people was variable and unpredictable. For some, except for a brief return something

close to normality, it was a failure. For others, its effects were beneficial over a longer period,

and for a few, there was a return to a long lasting near normality. The drug raised enormous

expectations in those who been worst affected by sleepy sickness, who for thirty or forty years

had been in a kind of catatonic sleep. Tragically, for some of them, their awakening was all

too brief

 

 

 

 

Leonard’s poem:

 

THE PANTHER by Rainer Maria Rilke (1875-2926)

 

His vision, from the constantly passing bars,

has grown so weary that it cannot hold

anything else. It seems to him there are

a thousand bars; and behind the bars, no world.

 

As he paces in cramped circles, over and over,

the movement of his powerful soft strides

is like a ritual dance around a centre

in which a mighty will stands paralysed.

 

Only at times, the curtain of the pupils

lifts, quietly -. An image enters in,

rushes down through the tensed, arrested muscles,

plunges into the heart and is gone.

 

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