The Ethical Teaching of Psychology in High Schools - When We Should NOT Use Role Play

A few weeks ago, a guest blogger (Dr. Ian) talked about some things we, as High School teachers, may want to avoid from an ethical perspective. He spoke of NOT using original images like the TAT, Rorschach Ink Blots, or IQ test questions from a live test in class because it disrupts the clinical use of those tests.

I receive a lot of positive feedback and emails from people, the message being, "Wow. I never thought of that...I'll take his suggestions and amend my curriculum! Thanks."

Since this post received so much positive feedback, I was reminded of a session I attended at a recent conference and a conversation I had after the conference with Dr. Kris Vespia, a professor at UW-Green Bay and a licensed counselor. Dr. Vespia had some suggestions for teaching therapy in the high school setting, and I wanted to pass along her ideas and advice to people who didn't have the good fortune to attend the conference.

UWGB Professor Dr. Kris Vespia

Follwing is my interview with Dr. Vespia:

What are some of your favorite tools to teach students about therapy and techniques?

I’m going to answer a different question than the one you asked (I know, I know – we would not give our students full credit for that kind of behavior!). The truth is I do not focus on teaching therapy “techniques,” and I would be even less likely to do so with high school students particularly due to ethical concerns.  I teach an upper-level college class called “Counseling and Psychotherapy,” and we go into some depth about several theoretical approaches to therapy. Even in that context, I focus more on theory, research, case conceptualization, and ethical and/or professional issues than “techniques.”

Now, to answer your question at least partially, what I would probably focus on for a high school or Psych 102 unit on psychotherapy would be one or more of the following topics: a) defining psychotherapy and/or the counseling process (relationship, assessment, conceptualization, etc.) in detail; b) reviewing the theoretical basis of therapy approaches; c) examining therapy research; and, possibly, d) exploring future directions for the field. Here are some resources that could be helpful.

Defining psychotherapy: http://www.apa.org/helpcenter/understanding-psychotherapy.aspx; http://www.apa.org/helpcenter/psychotherapy-myths.aspx; http://www.mentalhealth.gov/basics/myths-facts/ (Create a myths vs. facts game for class?) 

The theoretical basis of therapy: Provide a case study to students and ask them to conceptualize the underlying cause of the same client’s depression from three different theoretical perspectives (e.g., Freudian psychoanalysis, feminist therapy, cognitive therapy)

Therapy research: Show students samples (e.g., abstracts) of actual studies (see one journal example here: http://psycnet.apa.org/journals/pro/46/3/). Introduce students to the idea of empirically supported treatments and their prominence in the field (here is one web-based source of information you might find helpful for your own reading: https://www.div12.org/psychological-treatments/frequently-asked-questions/ and https://www.div12.org/psychological-treatments/treatments/)

Future directions: There always seem to be new and interesting topics to bring into this particular unit. For example, there is an increasing interest in the use of technology in therapy (e.g., telehealth, use of email or apps as adjuncts in therapy) and associated research and ethical issues.   

Do you have any favorite videos that show therapy techniques that you use in your classes?

My favorite videos are not going to be terribly helpful because they are ones I have accumulated over the years that are typically pretty expensive and may even have ethical restrictions on who can view them (e.g., to undergraduates vs. graduate students vs. practicing professionals). In terms of more open access videos, Psychotherapy.net is a large seller of DVDs and streaming video, but you can typically access 3-5 minutes clips of these as previews. That can give students a nice glimpse into what a specific therapy is about by hearing from an expert in it. I would say that I tend to avoid Hollywood movie or TV depictions of therapy because they are often so bad. They can be fun to show, though, if used as a part of an activity to have students brainstorm what is realistic/accurate about the clip and what is not.

Would you recommend having students practice therapy techniques or "simulate" therapy on each other in a Psych 101 or high school class? If no, why not? What are the dangers?

No! In fact, here is the disclaimer that I put on the syllabus for my Counseling & Psychotherapy course each semester. We will review a variety of theoretical approaches to counseling during the semester. Although you may be exposed to counseling techniques in your textbook and in lecture, you should never attempt to use these techniques, which can cause harm when used inappropriately. This class is not in any way designed to teach you to counsel others. Graduate-level training and supervision are necessary to do that kind of work. There are two major problems I have with the idea of encouraging role play of therapy techniques. First, if we have students “practice” on each other in high school or college, we may send a message that therapy is simple and not much more than being a supportive person and/or good listener – or a message that mental illness is not serious and can be “cured” just with support. We would not, after all, have high school or college students practice on each other medical techniques a physician would use to treat physical illness. My larger concern, though, is an ethical one – people could actually be harmed. Even if what happens is just students role-playing supportive conversation, not counseling, with one another, those in the “client” role often end up role-playing a situation that is real to them. Just talking about that situation can bring up unresolved emotions and reactions (e.g., crying, trembling, raising voices) they were not expecting in the classroom. In addition, students may take techniques they “learned in school” and believe they can use them to help others. What is noted above in my syllabus warning is true, though. For example, relaxation exercises may seem harmless and very easy to teach, but for some people using a relaxation technique can actually induce a panic attack instead.

Being an expert in counseling, you obviously deal with many persons with disordered behavior or mental health conditions - is it ok to "act out" disorders in a classroom as a means to teaching students about disorders? 

I would strongly advise against any “acting out” of disorders. From a basic educational perspective, I think it is almost impossible to communicate accurate, high quality information about mental illness that way. It also tends to promote a view that "all people with..." act the same way or have the same symptoms, which is not the case. Professionally and ethically, it likely contributes to stereotypes and stigma surrounding mental illness, which are significant problems. The “acting out” can also trivialize mental illness and lead to reactions like laughter about it in the classroom. Imagine how painful that could be to someone in the class who has a mental illness diagnosis or knows someone personally who does. If the goal is to help students learn more about specific mental illnesses, then there are good professional resources available as an alternative. If you want to learn more about stigma or address that as a topic in class, there is a very large research literature available (P. Corrigan is one key author in that field). 

Here are a couple of other types of resources available online: https://www.psychologytoday.com/blog/brick-brick/201405/the-stigma-mental-illness-is-making-us-sicker and http://bringchange2mind.org/learn/what-is-stigma/

You might also examine some of these resources and look for similar ones yourself. There are many, many misunderstandings of genuine mental illness (e.g., Major Depressive Disorder is just “feeling sad”). This TED-Ed lesson provides a wonderful illustration: http://ed.ted.com/lessons/what-is-depression-helen-m-farrell Students may also appreciate hearing people with different diagnoses talk about their experiences. For example, a TED talk by attorney and professor Elyn Saks challenges many of the misconceptions students may have about the illness while still acknowledging its severity. (Connect via this playlist: https://www.ted.com/playlists/175/the_struggle_of_mental_health) Of course, you will need to evaluate whether the content is appropriate for high school classrooms.

Any other considerations or tips for teaching Therapy in a high school psychology classroom, it is literally my least favorite topic. Ever. to teach. 

The great news for those of you in this position is that therapy is just one unit (perhaps a week?) in a much longer class, and you can link therapy to almost any core unit in psychology that you do love to teach! Here’s one suggestion. Rely on students’ reading the textbook for your “content coverage” and have your own material in class supplement that content with in-depth treatment of more focused issues. It is a great opportunity to evaluate students’ ability to deal with independent reading, and it frees you to use supplementary material that links most closely to your own interests and expertise. For example, if you love research, you can go in depth with types of therapy research, common methods used, and special ethical considerations with therapy studies. On the other hand, if biological psychology is your passion, you can bring in material about associations between therapy and biochemical changes in the brain or discuss the increased use of psychologists in primary health care settings with physical problems.

Thanks to Dr. Vespia for her thoughts on such an important topic! 

----- Posted by Amy Ramponi