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Stimulating Ethical Awareness

Stimulating Ethical Awareness
STIMULATING ETHICAL AWARENESS DURING TRAINING

Henry Abramovitch, Israel Institute of Jungian Psychology

 

When one reads Jung, one cannot fail to notice the overall emphasis he placed on ethics throughout his work. (Proulx 1994, p. 102)

 

Everyone agrees that ethics is important, at least in theory. Most of us, however, are reluctant to face the reality of ethical violations and how commonly they occur in practice.1 According to one careful survey, the ratio of unreported to reported sexual misconduct cases was thirty-seven to one (37:1) (Parson & Wincze 1995).

Such ethical violations e.g. sex with patients, are in essence un-repairable. The restorative justice necessary is so rare, as so movingly and painfully described in “The unfolding and healing of analytic boundary violations” (Anonymous 2005). Ironically, analysands tend to report such boundary violations not when they occur, but only at the end of the affair. Yet ethical violations when they do occur are often so distressing that without careful and regular preparation, they are often handled in an unsatisfying, or even unethical manner with all parties feeling more hurt and victimized at the end of the process. (Kast 1995). “[E]ven when the professional has fulfilled all of the requirements of the regulatory agency, has gone to treatment, has gotten supervision, has attended ethics classes, has paid fines, and has lost privileges, the primary and secondary victims are left in a continuing state of distress.” (Brown 1997, p.297). Nevertheless, many analysts feel 'as if thinking about ethical issues is an unwelcome disruption or intrusion into the real analytical task'. (Solomon 2004, p. 250).

Stimulating ethical awareness during training must instill values that would prevent these violations in the first place. Ethical awareness, I argue, is akin to muscles – both need to be kept in shape otherwise they may prove useless in a real crisis. (Abramovitch 2005; in press).

Everyone agrees that trainees need to know about ethics but there is no consensus on how it should be taught. In the recent international survey by Liliane Wabha for IAAP Ethics Committee, she discovered that a quarter of societies had no programmed activity concerning Professional Ethics at all, nor were all of these open to trainees (Wahba 2005). Nor was there consensus concerning what should be taught. Some felt the key ethical dilemmas concerned admission requirements; others, dual relations or power relationships and guidelines for ethical complaints; the ethics of supervision and the inevitable conflict in our dual roles as teachers and analysts, which of course violate our own Codes (cf. Pope, Tabachnik & Keith Spiegel 1987). I might add that the survey sent to all societies resulted in only 8 responses suggesting that the true nature of ethical education for trainees is probably far worse. Each training institute has its own ethical history – some societies are imbued with the integrity and uprightness of their founders; others have terrible ethical skeletons in their communal closet of how founders abused patients, candidates and each other.

The survey revealed that ethics is mostly taught only as a theoretical subject, drawing on the classic work of Jung (1960; CW 10; Proulx 1994) Neumann (1990) and others (Ross & Roy 1995; Zabriske 1995; Eisold 1994; 2001). Recent work has focused especially on the need for an ethical space (Wiener 2001), an ethical attitude (Solomon 2004; Solomon & Twyman 2003) and a new approach to the ethics of publishing clinical material (Wharton 2005). These very valuable contributions to our thinking about ethics, do not always help candidates, analysts and supervisors in a crunch, when they are faced with heart-throbbing dilemmas or situations in which the choice is not between good and bad, but bad or worse. Primo Levi (1958) called these the “grey zone”1b

To equip candidates with the necessary attitude towards proper and improper behavior, they need to get to know and explore the grey zone. The question remains how.

My personal view is that we need to stimulate, develop and cultivate ongoing ethical awareness in our candidates and our training programs as part of active ethical muscle building program that pervades the entire institute. Ethical matters take place at the intersection of how we appear to ourselves and to others (persona), and the archetypal values and ideals we all hold so dear (self); it is at once intensely personal, but essentially collective. We each “know” what is right, as part of our individuation process; yet at the same time, living together in institutes, we must have shared rules, rules which we often inherit with our training. We require a third way linking these two opposites, along what might be called the Persona-Self axis (Abramovitch 1993). This third way involves stimulating ethical awareness in each member yet within the group life of each society.

 

THE TALMUDIC APPROACH

My proposal is that candidates need to confront actual and virtual cases of ethical dilemmas, which explore the length and breadth of the gray zone.

In the remainder of my presentation, I am going to try to illustrate the kind of workshop that I have been running for members and candidates of my Institute (Israel Institute of Jungian Psychology - IIJP), and at other societies and developing groups where I have been invited. These are not theoretical or intellectual seminars (although these are also important) but direct, personal confrontations with ethical dilemmas in a protected space and I want to run the rest of my presentation in that format. I will clarify a task, take a moment to think about it and then briefly, I will give time for you to share your reflections with your neighbour.

THE WORST THING YOU CAN DO:

My first suggestion is an active imagination that seeks to clarifies the far boundaries of damage which we as analysts can cause. Take a moment to consider and then share with your neighbour:

What is the worst thing an analyst can do?

[pause]

What is the worst thing a candidate can do?

[pause]

What is the most dangerous thing?

[pause]

 

In my experience, there are fascinating personal and cultural differences in how these questions are answered. In Israel, people were most concerned with actual or symbolic abandonment, perhaps against the cultural complex of holocaust and war. In Hong Kong, people felt most wary of over-identifying with the role of “expert” so much part of traditional Confucian values; elsewhere, there was much concern over the analytic container; or overt sadism and symbolic or even literal violence. The list appears unending. A personal favourite is the analyst who deliberately does not coming to a scheduled session.

What was fascinating was that many of these “worst things” were not specifically covered or prohibited by the Society’s Code of Ethics.

 

PUBLIC READING OF CODE OF ETHICS

How many of you (and your candidates) are familiar with the codes of ethics, or know the exact procedures for making and processing an ethical complaint?

[pause]

When I recently gave a workshop on ethics at unnamed institute, I asked to see their code of ethics in advance. It took the group months of searching to finally locate a current copy.

In order to make the ethical codes a living document, I encourage a public reading of the Code of Ethics and Code of Ethical Practice, and literally studying it line by line. This is a public effort to make the Code of Ethics a living pledge which crystallizes the shared consensus of a moral community and not ‘a mere checklist that may be forgotten as long as it is not transgressed’ (Solomon 2004, p. 263). The continual re-reading and restudying the code by candidates is akin to the Hebrew tradition of reading and re-reading the Bible Sabbath after Sabbath, year after year. It serves as reminder that these words have moral force that binds us together as an ethical community. In some causes, it helps clarify the often ambiguous or vague language of the code or even to significant revisions in the code itself. In English, one says, “The Devil is in the details”; but in Hebrew, one says “God is in the details”.

Consider the “Preamble to the Ethical Code of Korean Association of Jungian Analysts” which includes quotes from Lao Tzu (as well as Jung)2:

“Tao in the Universe is like the south-west corner in the house

It is the treasure of the good man, the support of the bad.” (Laotzu: Tao Te Ching, Chap 62). followed by: “The above words are seriously to be considered in administering these regulations”. I am sure I really do not understand the full significance of the quote, but it does evoke a strong sense of “The Third” and Transcendent function.

Public declaration of such preambles may go a long way to heighten “moral sensitivity” (Welfel & Kitchener 1992).

 

KEY CASES

However, the main activity to help trainees to know their grey zones is by the detailed analysis with key cases, examined in what I call a Talmudic manner.

The Talmudic approach is in some ways the opposite of the Code approach.3

While Codes of Ethics describe ideal modes of behavior; and Codes of Practice specify the details of how to handle actual complaints, these important documents do not always illuminate the “gray area” between what is clearly forbidden and what is absolutely allowed. What makes a discussion Talmudic is a method in which formulations are challenged by specific examples designed to test the conceptual consistency of the formulation. Intellectual inquiry is grounded in examples rather abstractions. (Steinsaltz 1977). The goal is to creatively think through all the theoretical possibilities of the case and so have ethical muscles primed for any eventuality that may arise.4

The following case is taken from a draft of the forthcoming IAAP Ethics & governance Case Book which will hopefully begin to appear on IAAP website (www.iaap.org) in the near future.

 

SAMPLE CASE : THE DYING ANALYST

1. A colleague comes to you and says that they have just received a diagnosis of colon cancer with an average survival time of18-24 months. Analyst has a full practice including analysands, candidates in analysis and in supervision.

Analyst is receiving palliative care, and feels well enough to continue working. Analyst feels, in fact, that the illness has made them a better more attuned analyst. But analyst is not sure what to do. They have come to you for advice.

Questions to be discussed:

What would you like to ask the analyst?

[pause]

What are the ethical implications?

[pause]

Are the issues different for analysands, candidates, control candidates/supervisees? [pause]

Would the kind of cancer make a difference?

[pause]

Would a change in expected survival time to 3 months, 6 months or 4 years make a difference?

[pause]

Should the analyst tell his patients? Candidates? Supervisees?

[pause]

If so, what should analyst say to analysands and when?

[pause]

At what point should he stop practicing?

[pause]

If he does decide to stop practicing, how should he do it?

[pause]

Should the analyst have a mechanism in which patients, candidates and supervisees can be informed in the event of his or her unexpected death?

[pause]

Does the age of the analyst play a role? The gender?

[pause]

Would it make a difference if the case concerned a candidate and not an analyst?

[pause]

How would you deal with the situation in which the same analyst does not come to you for a consultation but you hear rumors, hear from trainees or see for yourself?

[pause]

Would you approach?

[pause]

How would you approach?

[pause]

What could you do if rebuffed? Should you try again?

[pause]

At what point would you refer the case to the Ethics Committee?

[pause]

How would you act, if you were the analyst?

[pause]

What would be your advice?

[pause]

Although patients of seriously ill or dying analysts ought to be transferred ahead of time, I know from personal experience with dying colleagues how difficult it was for them to let go of their patients who provided them with so much vitality and meaning in their last days. (Kaplan & Rothman 1986). On the other, the death of an analyst can have a profound and disturbing effect, even over decades. What does emerge from this case is the need for Ethics Committee to play a consultative role when analysts are uncertain of the correct way to proceed.

Other cases might revolve around boundary violations

e.g. Analyst suddenly and unexpectedly kisses a candidate.

Or, to use a typical Talmudic phrase, “And what if the opposite were true?” If the candidate kisses the analyst: What should be done? Is the analysis permanently damaged/polluted? Candidates in such situations rarely lodge a complaint, why?

In another type of boundary crossing, an analyst disparages another analyst in the presence of their analysands; or the opposite: a candidate disparaging an analyst in the presence of their analysand/supervisee/colleague…

What should be done? When should such actions be reported to Ethics committee or some other authority?

 

SIMULATION OF AN ETHICAL COMPLAINT:

Ethics Committees almost always require strict confidentiality. As a result, the delicate expertise acquired in dealing, processing resolving and mediating complaints does not percolate through the Institute but remains private knowledge. New members of the committee are often forced to learn ‘on the job’.5

In educating physicians, it is now standard practice to use simulated patients, who respond to medical students according to how they are related to. The entire interaction is videotaped and the physician/medical student receives immediate feedback first from the simulated patient/actor, and then from trained facilitators first in a group learning environment and then individually in-depth with their tutors.6

This revolution in medical education (in the past, individuals would become doctors without anyone ever having directly observed how they actually interacted with patients) changed the culture of learning. Intimate areas of interaction must be open to public scrutiny and performed at a minimally acceptable level. In analytical psychology, we almost exclusively rely on candidate reports and supervision but I wonder if the same revolution may eventually come into training analysts and psychotherapists. However, it can certainly be applied to learning how to deal with ethical complaints. The first time student-physicians perform patient interviews or rectal exams should not be their first attempt; likewise, I propose that when an analyst conducts an ethical investigation, it should not be their first learning experience. The entire process of an ethical complaint from beginning to end, can be easily simulated via role playing. Each of the roles – plaintive, accused analyst or candidate, members of the ethics committee, witnesses, appeals committee members etc. There is inadequate time for a fullscale simulation, but to give you a taste:

“Imagine that during the course of an analysis, your senior elderly analyst becomes increasingly forgetful and confused. Finally, you realize, they are becoming increasingly cognitively impaired. You are sure that members of the society were aware of the individual’s condition and colluded to ignore it. You are enraged, file a complaint and demand that the analyst be suspended and your fees be repaid.”

[pause]

“Now imagine that you are the senior analyst appears before the Ethics committee and deny all the allegations as ridiculous and refuse to consider undergoing a medical exam or psychiatric evaluation, claiming that the patient is merely acting out a negative transference”

[pause]

“Now imagine you are member of the ethics committee, who must deal with the complaint. You must speak to the senior analyst, a respected member of the analytic community and in the past, your control analyst.

Imagine how you would approach the senior analyst.”

[pause]

Victims of ethical violations want ‘to have the therapist apologize directly, in person, and with no excuses; to listen to the client’s expression of pain, anger and betrayal; and to affirm that she, the victim, had no hand in causing the boundary violation.’ (Brown 1997, p.298). As a member of the Ethics committee, what can you do to bring that genuine apology and affirmation, if you feel the complaint is justified?

[pause]

SECRECY

So much of what we do as analysts is private or secret. As a result, many of our candidates (and analysts) are forced to deal with painful and perplexing ethical conflicts on their alone. Yet, there is a growing consensus that secrecy, doing something you would not want to become known, is one of the key warning signals that you are on the slippery slope towards an ethical violation. Shame, however, makes it all the more likely that the analyst or trainee will try to hide the act from others, and its implications from oneself. “Is this what a therapist does?” is a question we should be continually asking ourselves as we approach the gray zone, and if we hesitate, even momentarily, then we are at risk. (Gutheil & Gabbard 1993, p. 188). One of the main points made by Ethics Case Book of the American Psychoanalytic Association is that ‘no one should have to deal with such troubling ethical dilemmas alone’ (Dewald & Clark 2001, p. 49). They are strong advocates of the importance of making use of consultations with colleagues, and I would add also with Ethics Committee, serving as institutional resources and not merely investigative bodies. Candidates also need to be encouraged to report “near miss” ethical violations in a no-fault manner, as in the aviation industry. Only by analyzing these ‘critical incidents’ did the airlines learn how to prevent crashes; we can do the same with ethical violations (Bersoff 2003, pp. 225-232). In our training, we need to create safe, public spaces to allow trainees to discuss their own false steps and uncertain experiences with their teachers.

Together, we can learn to act as each others’ ethical resource.

 

INDIAN WISE MEN

I want to close with two texts by Indian Wise Men, honoring the original inhabitants, Algonquin and Iroquois who lived on this island, they called Hochelaga. The first pinpoints the tragic dichotomy between virtue and power: “The good are not strong; and the strong are not good.” Yet to be ethically powerful analysts, we need to be both good and strong. The second is a Message from Hopi Elders sent out in 2001 and now is often read as an invocation at conferences that deal with bravery of the heart, community of the spirit and becoming who we truly are meant to be:

Message from a HOPI-Elder7

There is a river flowing now very fast.

It is so great and swift, that there are those who will be afraid.

They will hold onto the shore, they will feel they are

Being torn apart and will suffer greatly.

Know that the river has its destination.

The elders say we must let go of the shore,

push off in to the middle of the river,

keep our eyes open and our heads above the water.

And I say:

See who is there with you

and celebrate!

At this time in history

we are to take nothing personally,

least of all ourselves,

for the moment we do,

our spiritual growth and journey comes to a Halt.

The way of the lone wolf is over.

Gather yourselves.

Banish the word struggle

from your attitude and vocabulary.

All that we do now must be done in a sacred manner

and in celebration.

 

WE ARE THE ONES WE HAVE BEEN WAITING FOR.

REFERENCES:

Henry Abramovitch (1993). ‘Disguise as a Transition to Homecoming.’ In The Transcendent Function: Individual & Collective Aspects. Proceedings of the 12th International Congress for Analytical Psychology. (ed. Mary Ann Mattoon).

Einsiedeln, Switzerland: Daimon Verlag. pp. 250-7.

Henry Abramovitch (1995).. ‘Ethics: a Jewish perspective’ in Cast the First Stone: The Ethics of Analytical Therapy (eds. L. Ross & M. Roy) Boston: Shambhala. 1995. pp. 31-6.

Henry Abramovitch (2005). ‘Die Anregung ethischen Bewusstseins: Ein talmudischer Ansatz’ Analytische Psychologie 36; 140 (2) 123-6, 2005.

Henry Abramovitch, (in press). “Stimulating Ethical Awareness: a Talmudic Approach”

Journal of Analytical Psychology, in press.

Anonymous, “ The unfolding and healing of analytic boundary violations: personal, clinical and cultural considerations” Journal of Analytical Psychology 50:661-691, 2005.

J. L. Bernard & Carmen S. Jara. (1968). ‘The failure of clinical psychology graduate students apply understood ethical principles’ Professional Psychology: Research and Practice 17, 313-5. Reprinted with commentary in Bersoff 2003, pp.77-80.

Donald N. Bersoff (2003). Ethical Conflicts in Psychology. 3rd ed. Washington: American Psychological Association.

L.S. Brown (1997). ‘Remediation, amends, or denial?’ Professional Psychology: Research and Practice 28, 297-299.

Paul A Dewald, & Rita W. Clark. (2001). Ethics Case Book of the American Psychoanalytic Association. New York: American Psychoanalytic Association.

Glen Gabbard & Eva Lester, Boundaries and Boundary Violation in Psychoanalysis.

New York: APA. 1995.

Thomas G. Gutheil & Glen O. Gabbard (1993). ‘The Concept of Boundaries in Clinical Practice: Theoretical and Risk Management Dimensions’ American Journal of Psychiatry 150, 188-196.

Kenneth Eisold (1994). “The Intolerance of diversity in psychoanalytic institutes.”

International Journal of Psycho-Analysis 75, 785-800.

Kenneth Eisold (2001). “Institutional conflicts in Jungian analysis.”

Journal of Analytical Psychology 46:335-354.

Jung C. G. (1960) ‘Good and Evil in Analytical Psychology’ Journal of Analytical Psychology 5, 91-100. [CW 10, 456-68]

Jung, C.G. (1959). ‘A psychological view of conscience’ CW 10, 437-55.

Kast, Verena (1995). ‘How to handle unethical behavior in an ethical way’ in Lena Ross & Manisha Roy (Eds.) Cast the First Stone: Ethics in Analytical Practice.

Wilamette, Il.: Chiron. pp. 75-81.

Arnold A. Lazarus (1994). ‘How Certain Boundaries and Ethics Diminish Therapeutic Efficiency.’ Ethics and Behavior 4, 255-61.

Primo Levi (1958). Se Questo e un Uomo. Turin: Einaudi. [Survival in Auschwitz,

Translated by Stuart Woolf. New York: Touchstone. 1996.]

Erich Neumann (1990). Depth Psychology and the New Ethic. Boston: Shambhala.

J. L. Parson & J.P. Wincze (1995). ‘A survey of client therapist sexual involvement in Rhode Island as reported by subsequent treating therapists.’ Professional Psychology: Research and Practice 26, 171-175.

Kenneth S. Pope, Barbara G. Tabachnik & Patricia Keith-Spiegel (1987). ‘Ethics of Practice: The Beliefs and Behaviors of Psychologists as Therapists’ American Psychologist 42, 993-1006.

C. Proulx (1994). ‘On Jung’s Theory of Ethics’, Journal of Analytical Psychology 39, 101-119.

Lena Ross & Manisha Roy (Eds.) Cast the First Stone: Ethics in Analytical Practice.

Wilmette, Il.: Chiron. 1995.

Hester Solomon & Mary Twyman (Eds.) (2003). The Ethical Attitude in Analytical Practice. London: Free Association.

Hester Solomon (2004). “The Ethical Attitude in Analytic Training and Practice” in Analytical Psychology: Contemporary Perspectives in Jungian Analysis (Joseph Cambray & Linda Carter, Eds.) London: Brunner-Routledge. pp. 249-265.

Liliane Wahba (2006). ‘Report on Training for Ethics in IAAP.’ IAAP Ethics Committee.

Unpublished Report.

Elizabeth Reynolds Welfel & Karen Strohm Kitchener (1992). ‘Introduction to the Special Section: Ethics Education – an Agenda for the ‘90s.’ Professional Psychology: Research and Practice 23, 179-181.

Jan Wiener (2001). ‘Confidentiality and paradox: the location of ethical space’ Journal of Analytical Psychology 46, 431-442. [Reprinted in Solomon & Twyman 2003]

Barbara Wharton (2005), “Ethical issues in the publication of clinical material”

Journal of Analytical Psychology 50, 83-90.

Beverley Zabriskie, “Ethics” in Jungian Analysis (Murray Stein, Ed.). 2nd Edition.

Open Court, 1995. pp. 405-415.

Luigi Zoja (2006; in press). ‘The Elaboration of Complexity’. The Fay Lecture Series, Texas A & M Unversity, College Park, Texas. June 2, 2006.

 

NOTES:


1 The Ethics Case Book of the American Psychoanalytic Association (Dewald & Clark 2001, p.xxx-xxxi) lists seven factors why professional ethics need attention at this time:

1. Awareness that ethical violations and boundary crossings are ubiquitous and have occurred more frequently than previously acknowledged, and that these violations have serious negative effects on the reputation of the profession in public opinion.

2. consciousness raising and prevention are easier and less expansive to implement than handling a violation after it has occurred. Ethical violations result in significant damage to the analysand, the analyst and the psychoanalytic community.

3. Awareness and concepts of professional ethics have become much more sophisticated and are not limited to sanctions for “bad behavior”.

4. Increasing recognition both of the role of the analyst’s behavior in the development and maintenance of analytical process, and the analyst’s countertransference and continuing need for self observation.

5. The need to demonstrate to colleagues, students and the general community the importance given to these issues by psychoanalytic institutions.

6. The increasingly litigious nature of society and the mounting frequency of malpractice lawsuits.

7. The importance of open discussion and sharing of ethical concerns and differences of opinion, so that a consensus about ethical behavior becomes an expectable part of professional climate.

1b Lugi Zoja made the “gray zone” a major theme in his recent Fay Lectures: “Describing his experience of survival in Auschwitz, Primo Levi often resorts to the image of the “gray zone”. Movies and fictions have often exploited commercially (may we say ab-used?) the suffering of Auschwitz. In these representations, the strain of ethical elaboration is usually avoided. Good and evil are predefined and simplified. Levi’s analysis derives, on the contrary, from his personal suffering and ethical reflection and comes up against an often unsolvable complexity.

In the extermination camp, besides black and white realities there is open ground for a vast “gray zone”. Immorality is ever present, but often intermingled with humanity to the point of no distinction. Life has a higher value than most of our rules. Daily food allowances are part of the extermination project, in that they are insufficient for survival. Stealing, cheating and other usually unacceptable behavior become necessary. On the other side, among guards, corruption and tolerance of misbehavior become a virtue. A review of the polarities of good and evil does not contribute to a moral education or to a debate on ethics. An analysis of the gray zone does.” (Zoja 2006).

2 The complete Preamble of the Korean Association of Jungian analysts is as follows:

It was when the Great Way declined

That human kindness and morality arose;

It was when intelligence and knowledge appeared

That the Great Artifice began (Laotzu: Tao Te Ching, Chap 18)

Tao in the Universe is like the south-west corner in the house

It is the treasure of the good man, the support of the bad.

(Laotzu: Tao Te Ching, Chap 62)

The concept and phenomenon of conscience thus contains, when seen in a psychological light, two different factors: on the one hand a recollection of, and admonition by, the mores; on the other , a conflict of duty and its solution through the creation of a third standpoint. (Jung, C.G.. ‘A psychological view of conscience’ CW 10, p.455).

Kant rightly requires the individual and the society to advance from an “ethic of action” to an “ethic of conviction”. But to see into the ultimate depths of the conviction behind the action is possible only to God. Our judgment, therefore, as to what is good or evil in practice will have to be very cautious and modest, not so apodictic, as though we could see into all darkest corners. Jung C. G. ‘Good and Evil in Analytical Psychology’. CW 10, p. 462.)

3 Codes of Ethics have been much criticized by classical Jungians and others who feel that such rule-based, ‘one size fits all’ is detrimental to the spirit of the work and diminishes therapeutic efficiency (Lazarus 1994; Bersoff 2003, pp.233-8). Another author cites their arbitrariness: “Realistically, however, what a code of ethics does is validate the most recent views of a majority of professionals empowered by their colleagues to make decisions about ethical issues. Thus, a code of ethics is, inevitably, anachronistic, conservative, ethnocentric, and the produce of political compromise…[E]thical codes are “vaguely formulated and rarely enforced. Therefore they provide almost no specific and tangible guidance to either practitioners or clients.” “ (Bersoff 2003, p.1-2).

4 One study of clinical graduate students in psychology revealed that at least half would not live up to their own interpretation of the Ethical Principles. They understand what they should do but chose not to apply it. (Bernanrd & Jara 1968). In my metaphor, their ethical muscles were rather flabby.

“Much ethics training in courses has been criticized for concentrating on ethics codes and rules rather than on day-to-day ethical dilemmas in professional practice.”

Bersoff 2003, p.127

5 American Psychoanalytic Association ‘Provision for the implementation of the principles and standards of ethics for psychoanalysts states: “Each member [of the Committee on Ethics] shall serve a staggered five year term; members will be appointed each year to replace members whose term has expired.” (Dewald & Clark 2001, p.xvii).

This staggered approach allows for new members to become initiated into the work of the committee and in turn, initiate others. It does not, however, deal directly with the issue of diffusion of the knowledge through the Institute.

6 See, Syllabus, Dept of Behavioral Science, Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel where I hold an academic appointment of Professor & National Center for Simulation, Tel Hashomer Hospital, Ramat Gan, Israel.

7 This is an edited version of A Hopi Elder Speaks in 8th Day Centerings v. xxvii, No. 2/Winter 2001. (www.8thdaycenter.org). This journal is ‘published quarterly for sponsoring and subscribers as a tool for education and action in the search for peace and justice in the world.’