Ethical guidelines for psychological practice with men and boys 1. Introduction... 94 2. Justice... 94 3. Respect... 95 4. Competence... 95 5. Assessment... 96 6. Research... 97 7. Summary... 97 8. References... 97 93
1. Introduction 1.1. These Guidelines aim to inform psychologists about the ethical issues relevant to the provision of psychological services to men and boys, and highlight how gender role socialisation can sometimes negatively impact on the psychological health of men and boys. 1.2 Psychologists recognise and respect the diversity of male identities, including those associated with socioeconomic status, ethnicity, religion, culture, geographic location, gender identities, sexual orientation, and the ways in which these factors shape men s experiences, opportunities and health. 1.3. Psychologists who provide psychological services to men and boys understand the gendered dimensions of health and wellbeing, and the influences and implications of social determinants of health. They are aware of how theories of men and masculinities collectively contribute to the understanding of the way psychological services are provided to male clients. Some theories have addressed the impact of restrictive male gender roles and possible psychological problems related to masculine gender role conflicts in Western culture (O Neil, 2008). Other theories have addressed the social constructions of masculinities (Courtenay, 2000; Kimmel, Hearn & Connell, 2005). 1.4. The research into men s and boys gender role conflict emerged around the 1980s following the heightened awareness of restrictive gender roles (Pleck & Brannon, 1978). Gender role conflict is defined as a psychological state in which socialised gender roles have negative consequences for the person or others. Gender role conflict occurs when rigid, sexist, or restrictive gender roles result in restriction, devaluation, or violation of others or self (O Neil, 2008, p. 362). The negative consequences for men and boys related to gender role conflict and social constructions of masculinities can include anxiety, depression, homophobia, communication problems, difficulties with intimacy, marital conflict, restricted emotionality, violence towards women and other men, and substance abuse (O Neil, 2008). 1.5. Research has shown that compared to females, males have higher rates of some behaviour-related problems for example, suspension and expulsion from school (O Neil & Luján, 2009), educational difficulties for example, ADHD (Bruchmüller, Margraf, & Schneider, 2012), suicide (Kõlves, Ide, & De Leo, 2010; Värnik, 2012; Wyder, Ward & De Leo, 2009), and public health concerns for example as perpetrator and/or victim of violence (Moore & Stuart, 2005). 1.6. These Guidelines are to be read in conjunction with the APS Code of Ethics (2007) and the Ethical guidelines for working with young people (2009). 2. Justice Refer to the Code, standard A.1. Justice. A.1.1. Psychologists avoid discriminating unfairly against people on the basis of age, religion, sexuality, ethnicity, gender, disability, or any other basis proscribed by law. A.1.2. Psychologists demonstrate an understanding of the consequences for people of unfair discrimination and stereotyping related to their age, religion, sexuality, ethnicity, gender, or disability. A.1.3. Psychologists assist their clients to address unfair discrimination or prejudice that is directed against the clients. 2.1 Psychologists understand the range and diversity of behaviours and interests shown by male clients and ensure that sociocultural stereotypes do not limit their work with men and boys. 2.2. Psychologists are aware of the diversity of expression of maleness and masculinity across the lifespan (David, Grace, & Ryan, 2004; Wilson, 2006). Refer to Ethical guidelines for psychological practice with lesbian, gay, and bisexual clients (2010); and Ethical guidelines on working with sex and/or gender diverse clients (2013). 94 Ethical guidelines for psychological practice with men and boys
3. Respect Refer to the Code, standard A.2. Respect. A.2.1. In the course of their conduct, psychologists: (a) communicate respect for other people through their actions and language; (b) do not behave in a manner that, having regard to the context, may reasonably be perceived as coercive or demeaning; (d) do not denigrate the character of people by engaging in conduct that demeans them as persons, or defames, or harasses them. 3.1. When working with men and boys, psychologists use inclusive and respectful language that avoids the use of stereotypes or other forms of bias, such as sexist, sexualised or heterosexist language, jokes and derogatory, demeaning or infantilising terms. 3.2. When working with male clients, psychologists are aware of and address their own gender-related biases, stereotypes or prejudices. Psychologists take steps to minimise the impact of such factors on the effectiveness of the psychological services they provide. Where necessary psychologists seek supervision and/or make an appropriate referral. 3.3. Having regard to the context when providing psychological services, psychologists consider the potential impact of their own sex and/or gender on the client. Where indicated, psychologists explore and address male clients preference for a practitioner s gender. 4. Competence Refer to the Code, standard B.1. Competence. B.1.1. Psychologists bring and maintain appropriate skills and learning to their areas of professional practice. B.1.2. Psychologists only provide psychological services within the boundaries of their professional competence. This includes, but is not restricted to: (a) working within the limits of their education, training, supervised experience and appropriate professional experience; B.1.3. To maintain appropriate levels of professional competence, psychologists seek professional supervision or consultation as required. 4.1. Psychologists who provide psychological services to men and boys understand that the emerging research into the psychology of men and boys has highlighted the diverse and complex psychological, sociocultural, biological, gender role socialisation, developmental and economic factors relevant to psychological practice with male clients (see APA, in press; Gallardo & McNeill, 2009; Liang, Salcedo, & Miller, 2011; Mahalik et al., 2012; Schwing, Wong, & Fann, 2013). 4.2. Psychologists are aware of the social, developmental, environmental and emotional factors that may contribute to boys behavioural issues related to ADHD, impulsivity, and risk-taking behaviour (APA, in press; Bruchmüller et al., 2012). Refer to Ethical guidelines for working with young people (2009). Ethical guidelines for psychological practice with men and boys 95
Refer to the Code, standard B.3. Responsibility. B.3. Psychologists provide psychological services in a responsible manner. Having regard to the nature of the psychological services they are providing, psychologists: (a) act with the care and skill expected of a competent psychologist; (b) take responsibility for the reasonably foreseeable consequences of their conduct; (c) take reasonable steps to prevent harm occurring as a result of their conduct; (e) are personally responsible for the professional decisions they make; (f) take reasonable steps to ensure that their services and products are used appropriately and responsibly; 4.3. Psychologists understand that overall, men access psychological services at a lower rate than women (Berger, Addis, Green, Mackowiak, & Goldberg, 2013; Hammer, Vogel & Heimerdinger-Edwards, 2013; Yousaf, Grunfeld & Hunter, 2015), and are aware that male clients may disengage prematurely from a psychological service. Where possible, psychologists work with male clients to identify appropriate referral pathways and support options, and address identified risk factors. Refer to the Code, standard B.11. Termination of psychological services. B.11.2. When psychologists terminate a professional relationship with a client, they shall have due regard for the psychological processes inherent in the services being provided, and the psychological wellbeing of the client. B.11.3. Psychologists make reasonable arrangements for the continuity of service provision when they are no longer able to deliver the psychological service. 4.4. When working with male clients at risk of suicide, psychologists balance competing ethical principles such as client safety, client privacy, and client autonomy. Psychologists understand that males are at a heightened risk of death by suicide (Beaton & Forster, 2012; Värnik, 2012), and that major precipitants for suicide appear to vary between males and females (Berk, Dodd, & Henry, 2006; Wyder, Ward, & De Leo, 2009). Due to male clients heightened risk of suicide, psychologists are attuned to the indicators of suicidal thoughts or plans, and closely monitor the situation over time. 4.5. If psychologists identify any issues related to risk of harm to the client or others (including the practitioner), they consult with appropriate services and take steps to reduce the risk of harm. Refer to Ethical guidelines relating to clients at risk of suicide (2014); and Ethical guidelines for working with clients when there is a risk of serious harm to others (2013). 5. Assessment Refer to the Code, standard B.13. Psychological assessments. B.13.2. Psychologists specify the purposes and uses of their assessment techniques and clearly indicate the limits of the assessment techniques applicability. 5.1. Psychologists are aware of the theoretical and empirical support for assessment practices they use when working with male clients, including the degree to which these assessment practices have been found to apply to men. 5.2. Psychologists are aware of any gender bias in the psychological assessment instruments they select (APA, in press; Martin, Neighbors, & Griffith, 2013; Rice, Fallon, Aucote, & Möller-Leimkühler, 2013). Refer to Ethical guidelines for psychological assessment and the use of psychological tests (2009). 5.3. When compiling assessment reports psychologists avoid gender bias in the interpretation of the psychological assessments conducted. 96 Ethical guidelines for psychological practice with men and boys
6. Research Refer to the Code, standard B.14. Research. B.14.1. Psychologists comply with codes, statements, guidelines and other directives developed either jointly or independently by the National Health and Medical Research Council (NHMRC), the Australian Research Council, or Universities Australia regarding research with humans and animals applicable at the time psychologists conduct their research. 6.1. Psychologists are aware that there may be some limits to the generalisability of research findings to males in situations where participants of research studies are predominantly female. 6.2. Psychologists ensure that data generated from research are analysed using gender-sensitive tools and methods. 7. Summary Psychologists are aware of the diversity of identity and experience among men and boys, and the diversity of expression of maleness and masculinity across the lifespan. They are aware of the potential impact of social constructions of masculinities as well as gender role conflict on men and boys. Psychologists are aware of and address their own gender-related biases, stereotypes or prejudices, and they take steps to minimise the impact of such factors on the effectiveness of the psychological services they provide. They are aware of male-specific concerns that relate to the provision of psychological services. Psychologists understand the barriers that male clients frequently face regarding help-seeking, and are alert to males heightened risk of suicide. Where necessary they work with male clients to identify appropriate referral pathways and support options, and address any risk factors. 8. References American Psychological Association (in press). Guidelines for psychological practice with boys and men. Australian Psychological Society. (2007). Code of ethics. Melbourne: Author. Australian Psychological Society. (2009). Ethical guidelines for psychological assessment and the use of psychological tests. Melbourne: Author. Australian Psychological Society. (2009). Ethical guidelines for working with young people. Melbourne: Author. Australian Psychological Society. (2010). Ethical guidelines for psychological practice with lesbian, gay, and bisexual clients. Melbourne: Author. Australian Psychological Society. (2013). Ethical guidelines for working with clients when there is a risk of serious harm to others. Melbourne: Author. Australian Psychological Society. (2013). Ethical guidelines on working with sex and/or gender diverse clients. Melbourne: Author. Australian Psychological Society. (2014). Ethical guidelines relating to clients at risk of suicide. Melbourne: Author. Beaton, S., & Forster, P. (2012). Insights into men s suicide. InPsych: The Bulletin of the Australian Psychological Society, 34, 16-17. Berger, J. L., Addis, M. E., Green, J. D., Mackowiak, C., & Goldberg, V. (2013). Men s reactions to mental health labels, forms of help-seeking, and sources of help-seeking advice. Psychology of Men & Masculinity, 14, 433 443. Berk, M., Dodd, S., & Henry, M. (2006). The effect of macroeconomic variables on suicide. Psychological Medicine, 36, 181-189. Bruchmüller, K., Margraf, J., & Schneider, S. (2012). Is ADHD diagnosed in accord with diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis. Journal of Consulting and Clinical Psychology, 80, 128-138. Courtenay, W. (2000). Constructions of masculinity and their influence on men s well-being: a theory of gender and health. Social Science and Medicine, 50, 1385-1401. David, B., Grace, D., & Ryan, M. (2004). The gender wars: A self-categorisation theory perspective on the development of gender identity. In M. Bennett & F. Sani (Eds.), The development of the social self (pp. 135-157). Hove, UK: Psychology Press. Gallardo, M. E., & McNeill, B. W. (2009). Intersections of multiple identities: A casebook of evidence-based practices with diverse populations. New York: Routledge/Taylor & Francis Group. Hammer, J. H., Vogel, D. L., & Heimerdinger-Edwards, S. R. (2013). Men s help seeking: Examination of differences across community size, education, and income. Psychology of Men & Masculinity, 14, 65-75. Ethical guidelines for psychological practice with men and boys 97
Kimmel, M. S., Hearn, J., & Connell, R. W. (Eds). (2005). Handbook of studies on men & masculinities. Thousand Oaks: Sage. Kõlves, K., Ide, N., & De Leo, D. (2010). Suicidal ideation and behaviour in the aftermath of marital separation: gender differences. Journal of Affective Disorders, 120, 48-53. Liang, C. T. H., Salcedo, J., & Miller, H. (2011). Perceived racism, masculinity ideologies, and gender role conflict among Latino men. Psychology of Men & Masculinity, 12, 201 215. Mahalik, J., Good, G. E., Tager, D., Levant, R., & Mackowiak, C. (2012). Developing a taxonomy of helpful and harmful practices for clinical work with boys and men. Journal of Counseling Psychology, 59, 591-603. Martin, L. A., Neighbors, H. W., & Griffith, D. M. (2013). The experience of symptoms of depression in men vs women: analysis of the National Comorbidity Survey Replication. JAMA Psychiatry, 70, 1100-1106. Moore, T. M., & Stuart, G. L. (2005). A review of the literature on masculinity and partner violence. Psychology of Men & Masculinity, 6, 46-61. O Neil, J. M. (2008). Summarizing 25 years of research on men s gender role conflict using the Gender Role Conflict Scale: New research paradigms and clinical implications. The Counseling Psychologist, 36, 358-445. O Neil, J. M., & Luján, M. L. (2009). Preventing boys problems in schools through psychoeducational programming: A call to action. Psychology In The Schools, 46, 257-266. Pleck, J. H. & Brannon, R. (1978). Male roles and the male experience. Journal of Social Issues, 34, 1-4. Rice, S. M., Fallon, B. J., Aucote, H. M., & Möller-Leimkühler, A. M. (2013). Development and preliminary validation of the Male Depression Risk Scale: Furthering the assessment of depression in men. Journal of Affective Disorders, 151, 950-958. Schwing, A. E., Wong, Y. J., & Fann, M. D. (2013). Development and validation of the African American Men s Gendered Racism Stress Inventory. Psychology of Men & Masculinity, 14, 16-24. Värnik, P. (2012). Suicide in the world. International Journal of Environmental Research and Public Health, 9, 760 771. Wilson, G. (2006). Breaking through barriers to boys development: Developing a caring masculinity. London: Network Continuum Education. Wyder, M., Ward, P., & De Leo, D. (2009). Separation as a suicide risk factor. Journal of Affective Disorders, 116, 208-213. Yousaf, O., Grunfeld, E. A., & Hunter, M. S. (2015). A systematic review of the factors associated with delays in medical and psychological help-seeking among men. Health Psychology Review, 9, 264-276. Approved by the APS Board of Directors, June 2017. 98 Ethical guidelines for psychological practice with men and boys