Frustrations in the Gym

The purpose of this assignment is to examine ethical issues for professionals working in exercise psychology, rehabilitation, and in other professions related to physical activity as a means for maintaining individual health and well-being. Ethical principles and guidelines, previously discussed, will be applied to these various environments for critical analysis and discussion. Despite the differences in environments, the ethical situations exercise psychology professionals face, often, fall within the same parameters as those of other helping professions.

For this assignment, first, read the following article from the Argosy University online library resources:

Pauline, J., Pauline, G., Johnson, S., & Gamble, K. (2006). Ethical issues in exercise psychology. Ethics & Behavior, 16(1), 61–76.

Now, answer the following questions:

• Are issues of competency and training more complex for exercise psychology professionals than for applied sport psychology professionals?
• What ethical dilemmas are unique to the relationship between a client and an exercise psychology professional? Are there distinct differences in this relationship compared to a relationship between a client and a sport psychology professional?

Answer each question in 200–300 words. Your response should be in Microsoft Word document format. Name the file SP6300_M4_A1_LastName_FirstInitial.doc and submit it to the appropriate Discussion Area by the due date assigned.

Through the end of the module, comment on the posts of two of your peers. In your reviews, check whether the answers given to the second question support their answers to the first one. Discuss any inconsistencies or similarities in your classmates’ answers. All written assignments and responses should follow APA rules for attributing sources.

Assignment 1 Grading CriteriaMaximum PointsIdentified and described the differences in competency and training issues for exercise psychology professionals as compared to applied sport psychology professionals.8Analyzed and described the ethical dilemmas unique to exercise psychology professionals.8Compared the relationship between a client and an exercise psychology professional with that of the relationship between a client and a sport psychology professional.8Reviewed the posts of at least two peers and pointed out any inconsistencies and similarities.8Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate representation and attribution of sources, displayed accurate spelling, grammar, and punctuation.4Total:36

Ethical Issues in Exercise Psychology

Jeffrey S. Pauline, Gina A. Pauline, Scott R. Johnson,

and Kelly M. Gamble

School of Physical Education, Sport, and Exercise Science

Ball State University

Exercise psychology encompasses the disciplines of psychiatry, clinical and counseling

psychology, health promotion, and themovement sciences. This emerging field involves

diverse mental health issues, theories, and general information related to physical

activity and exercise. Numerous research investigations across the past 20 years

have shown both physical and psychological benefits from physical activity and exercise.

Exercise psychology offersmany opportunities for growth while positively influencing

the mental and physical health of individuals, communities, and society.However,

the exercise psychology literature has not addressed ethical issues or dilemmas

faced by mental health professionals providing exercise psychology services. This initial

discussion of ethical issues in exercise psychology is an important step in continuing

tomove the fieldforward. Specifically, this article will address theemergenceof exercise

psychology and current health behaviors and offer an overview of ethics and

ethical issues, education/training and professional competency, cultural and ethnic diversity,

multiple-role relationships and conflicts of interest, dependency issues, confidentiality

and recording keeping, and advertisement and self-promotion.

Keywords: ethics, exercise psychology, sport psychology

The emerging field of exercise psychology consists of diverse mental health issues,

theories, and general information related to physical activity and exercise. Exercise

psychology encompasses approaches from the fields of psychiatry, clinical

and counseling psychology, health promotion, and the movement sciences (Buckworth

& Dishman, 2002a). The establishment of optimal mental health with

nonclinical, clinical, and population based settings is often the primary focal point

of exercise psychology practitioners. Physical activity is viewed as a treatment

ETHICS & BEHAVIOR, 16(1), 61–76

Copyright © 2006, Lawrence Erlbaum Associates, Inc.

Correspondence should be addressed to Jeffrey S. Pauline, School of Physical Education, Sport,

and Exercise Science, Ball State University, Muncie, IN 47306-0270. E-mail: jpauline@bsu.edu

modality for mood alteration, management of psychopathology and stress, and enhanced

self-worth. Exercise psychology practitioners also focus on factors related

to exercise program characteristics that influence exercise adoption and adherence

for individuals, groups, and communities (Berger, Pargman, & Weinberg, 2002).

The field of exercise psychology and consulting has many opportunities for

growth. Potential employment opportunities can be found in the areas of colleges

and universities, management of corporate fitness programs, counseling in physical

rehabilitation clinics, and individual consultation with a diverse clientele. The

effectiveness of exercise practitioners or consultants is often dependent on their

ability to develop a collaborative relationship with their clients and other

professionals.

When consulting with exercisers and/or incorporating exercise into a traditional

treatment plan, mental health practitioners may feel as if they are treading in uncharted

waters due to some of the unique consultation circumstances and settings

in the exercise environment. Until now, the literature has not directly addressed

ethical issues or dilemmas related to providing exercise adherence counseling services

or including exercise as a component of a traditional treatment plan. The

heightened media attention and rising mental health care costs have increased the

allocation of funding by federal agencies (i.e., National Institutes of Health) to enhance

physical activity patterns. Therefore, the need and opportunity for practitioners

to assist with exercise adoption and maintenance is only going to increase

over the next decade as we continue to search for alternative treatment options to

fight physical health problems (e.g., obesity) and mental health issues. With this

increased opportunity and demand, the need to provide proper guidance to practitioners

implementing exercise as a component of therapy must be examined.

Thus, the remainder of this article will focus on selected ethical issues and potential

ethical dilemmas facing mental health professionals who provide exercise

adherence consultations and/or include exercise as a component of counseling or

therapy. Specifically, this article will address the emergence of exercise psychology

and current health behaviors, an overviewof ethics and professional resources,

education/training and professional competency, cultural and ethnic diversity,

multiple-role relationships and conflicts of interest, dependency issues, confidentiality

and recording keeping, and advertisement and self-promotion. In conclusion,

future issues and opportunities related to the field of exercise psychology will

be presented.

EMERGENCE OF EXERCISE PSYCHOLOGY

AND CURRENT HEALTH BEHAVIORS

The emergence of exercise psychology is due to the decline in lifestyle and behavioral

choices. In America today, choosing desirable health behaviors such as regu-

62 PAULINE, PAULINE, JOHNSON, GAMBLE

lar physical activity and a healthy diet are not typically practiced to the degree they

should be. According to the U.S. Department of Health and Human Services

(USDHHS; 2000) Healthy People 2010 report, only 22% of adults in the United

States engage in moderate physical activity for 30 min five or more times a week,

whereas nearly 25% of the population is completely sedentary. Furthermore, when

people do attempt to modify a lifestyle behavior by, for example, increasing physical

activity, many are unable to maintain the adapted behavior. The physical activity

adherence research reports dropout rates up to 50% within the first 6 months of

the start of an exercise regimen (Dishman, 1988).

The cause for weight gain in Americans has been clearly identified. Simply put,

we are eating more and exercising less than ever before. Americans are eating

approximately 15% more calories than in previous years (Putnam, Kantor, &

Allshouse, 2000). Combine the increased caloric consumption with the previously

mentioned physical activity patterns and you have a formula for weight gain for a

large segment of our society.

Based on the aforementioned statistics and data regarding obesity, diet, and

physical inactivity, the outlook may appear bleak. However, there is hope due to

the development of effective behavioral and cognitively based intervention strategies

to assist individuals with the adoption and maintenance of more active lifestyles

(Buckworth & Dishman, 2002b). Currently, there is an abundance of literature

indicating that the adoption of a more active lifestyle will enhance mental

well-being (reduce depression and anxiety and enhance self-esteem) while decreasing

the likelihood of developing obesity and other risk factors (i.e., high blood

pressure and cholesterol) for chronic diseases such as cardiovascular disease and

cancer (USDHHS, 1996). Furthermore, the literature clearly indicates that an individual

does not have to be an athlete or exercise vigorously to engage in beneficial

exercise (Public Health Service, 2001). The American College of Sports Medicine

(ACSM; 2000) training guidelines for physical fitness and exercise performance

recommends for aerobic activities 3 to 5 days per week of moderate-intensity exercise

for 20 to 60 min (in at least 10-min sessions) and weight training that includes

one or more sets of 8 to 12 repetitions of 8 to 10 exercises at least 2 days a week.

Interestingly, many practitioners are utilizing exercise as a therapeutic modality

to improve traditional psychological services. Hays (1999) indicated that exercise

can be utilized to cope with clinical issues (e.g., depression, anxiety, and weight

management), issues of daily living, and improving self-care. Exercise psychology

research supports the use of exercise as a treatment modality for both clinical and

nonclinical clients (Buckworth & Dishman, 2002a). Based on the well documented

physical and psychological benefits of exercise, psychologists and counselors

need to be aware of the benefits that can be gained by adding exercise to a

traditional treatment plan. However, due to issues pertaining to ethical dilemmas

and/or competency, some practitioners may believe it is unethical to include exercise

as part of a treatment plan despite the literature supporting its use.

ETHICAL ISSUES IN EXERCISE PSYCHOLOGY 63

For most people physical activity poses minimal risks. However, it is important

that all clients, regardless of ethnic or cultural background, obtain physician approval

to begin an exercise regimen. In addition to the physician approval, conservative

therapists desiring to add exercise to treatment should also have their clients

complete the Physical Activity Readiness Questionnaire (PAR-Q; British

Columbia Ministry of Health, 1978). The PAR-Q is designed to identify adults

who may not be suited to participate in physical activity due to various physical

ailments.

ETHICS OVERVIEW AND PROFESSIONAL RESOURCES

The purpose of an ethics code is to provide guidance and governance for a profession’s

members in working settings. An ethics code provides integrity to a profession,

professional values and standards, and fosters public trust through the establishment

of high standards (Fisher, 2003). It should be noted that no code of

conduct or set of ethical guidelines can account for all possible situations or ethical

dilemmas. Ethical codes are developed from the current values and beliefs in society

as related to a profession. These values and beliefs, as well as common professional

practices, can and do change with the passing of time due to numerous factors,

making it necessary for ethical codes and standards to also change.

The American Psychological Association (APA; 2002) ethics code is a well developed

and ever-evolving document that provides ethical principles and codes of

conduct to govern and guide its membership. In contrast, the Association for the

Advancement of Applied Sport Psychology’s (AAASP; 1994) ethical code is derived

from the APA’s (1992) ethics code and has not been updated since its inception.

It is designed to address issues specific to sport and exercise psychology

work. There are differences between APA and AAASP ethical principles and

codes. Those differences will be discussed later as they relate to exercise consultations.

Whelan, Meyer, and Elkin (2002) provided a detailed discussion of the

AAASP principles and ethical standards and serve as a good reference for a sport

and exercise psychology practitioner preparing to be or currently involved with

sport psychology consulting or exercise adherence counseling. Fisher (2003) and

Bernstein and Hartsell (2004) also serve as good sources for both general practitioners

and exercise consultants.

The ACSM is recognized by health professionals throughout the world as the

leading organization and authority on health and fitness. The ACSM’s primary focus

is to advance health through science, medicine, and education. Furthermore,

the ACSM (2003) has established a code of ethics with the principal purpose of

“generation and dissemination of knowledge concerning all aspects of persons en-

64 PAULINE, PAULINE, JOHNSON, GAMBLE

gaged in exercise with the full respect for the dignity of people” (¶ 1). To achieve

its principal purpose, the ACSM (2003) established the following four sections:

1. Members should strive continuously to improve knowledge and skill and make available to

their colleagues and the public the benefits of their professional expertise.

2. Members should maintain high professional and scientific standards and should not voluntarily

collaborate professionally with anyone who violates this principle.

3. The College, and its members, should safeguard the public and itself against members who

are deficient in ethical conduct.

4. The ideals of the College imply that the responsibilities of each Fellow or member extend not

only to the individual, but also to society with the purpose of improving both the health and

well-being of the individual and the community. (¶ 1)

Therefore, the ACSM is an excellent resource for mental health professionals to

consult for guidance concerning issues related to exercise, health, and fitness.

EDUCATION/TRAINING AND PROFESSIONAL

COMPETENCY MAINTENANCE

The field of exercise psychology is a merger between psychology and exercise or

movement science. Individuals specializing in either of these areas will have different

competencies and thus the ability to practice with different populations.

Most professionals recognize the value of having individuals in the field from both

backgrounds due to the uniqueness of their training. The APA (2002) ethics code

specifies that in emerging areas such as exercise psychology practitioners should

“take reasonable steps to ensure the competence of their work and to protect clients/

patients, students, supervisees, research participants, organizational clients,

and others from harm” (p. 5).

The ideal training for exercise therapists or consultants is an ongoing debate.

The two primary sources of training for exercise practitioners are (a) psychology

(i.e., counseling or clinical psychology) and (b) the movement sciences (i.e.,

kinesiology or exercise physiology). As previously mentioned, psychology and

movement sciences have been meshed together to form the discipline of exercise

psychology. However, these two disciplines are indeed separate and pose a complex

issue concerning training. Training for exercise practitioners is complex due

to licensure. Clearly, to refer to oneself as a “psychologist,” an individual must satisfy

the state requirements for licensure within the state in which he or she works.

Most people trained in the movement sciences can specialize in exercise psychology

but will likely not be able to meet the requirements for psychology licensure.

Thus, practitioners can not ethically refer to themselves as “exercise psychologists”

because they will not be licensed as psychologists within their state of em-

ETHICAL ISSUES IN EXERCISE PSYCHOLOGY 65

ployment. Likewise, licensed psychologists with limited or no training in the

movement sciences should not ethically refer to themselves as “exercise psychologists”

because of a lack of proper training in exercise science.

Education and training from both exercise or movement science and psychology

is a necessity for scholar–practitioners in the field of exercise psychology. Due

to the interdisciplinary nature of exercise psychology, students will most likely

need to create an individualized plan of study suited to meet their future goals and

career objectives by combining courses from traditional psychology, sport sciences,

and sport and exercise psychology. In 1991, AAASP established certification

criteria for becoming a certified consultant of AAASP. The interdisciplinary

requirements of AAASP certification require coursework and practicum guidelines

for students who desire or specialize in applied sport or exercise psychology

(Sacks, Burke, & Schrader, 2001). The requirements appear adequate and are necessary

but reflect only minimal foundational training. AAASP certification requirements

should not be viewed as sufficient training to become an effective exercise

consultant. Furthermore, the attainment of AAASP certification requirements

does not permit an individual to ethically use the title “exercise psychologist.”

The following is a recommendation of minimal interdisciplinary coursework

based on most state licensure requirements and AAASP certification, to be competent

to do specialized consultation in exercise psychology. This recommendation is

not a comprehensive list intended to address every possible career aspiration

within exercise psychology, but it can provide some initial guidance. The interdisciplinary

coursework should focus on the areas of psychology, sport science, and

sport psychology. The exercise psychology curriculum should include

1. Traditional psychology courses such as human growth and development;

biological, social, and cultural bases of behavior; counseling skills;

psychopathology; individual and group behavior; psychological assessment;

cognitive–affective bases of behavior; professional ethics and standards;

statistics; and research design.

2. Sport science courses should incorporate biomechanical and physiological

bases of sport, motor development, motor learning, fitness assessment,

fundamentals of strength and conditioning, aerobic and weight training,

and sport nutrition.

3. Last, sport psychology, performance enhancement, exercise psychology,

health psychology, and social aspects of sport and physical activity should

be included.

In addition to formal coursework, practical experience (i.e., internships and/or

practicum) focused on the application of psychological principles, theories, and

practices in the exercise setting is also a necessity. The practical experience must

be supervised by a qualified specialist (e.g., licensed psychologist, licensed mental

66 PAULINE, PAULINE, JOHNSON, GAMBLE

health practitioner, or certified consultant of AAASP) within the field of exercise

psychology. The aforementioned curriculum and practical training seems to provide

the necessary education for mental health professionals regarding the physical

and psychological benefits of exercise.

Nevertheless, this initial, formal coursework and applied experience is not in

and of itself enough to allow one to practice ethically throughout his or her career.

Maintaining professional competence through continuing professional education

is extremely important in any field, including exercise psychology. The scientific

and professional knowledge base of psychology and exercise/movement science is

continually evolving, bringing with it new research methodologies, assessment

procedures, and forms of service delivery. Life-long learning is fundamental to ensure

that teaching, research, and practice have an ongoing positive impact on those

desiring services (Bickham, 1998). Both APA and AAASP provide a variety of opportunities

and methods for scholars and practitioners to maintain professional

competency. Some of these methods include independent study, continuing education

courses or workshops, supervision, and formal postdegree coursework.

Maintaining professional competency is also an important ethical requirement

that is valued highly by the APA, the AAASP, and the ACSM. Over 96% of

AAASP professionals recently surveyed by Etzel, Watson, and Zizzi (2004) believed

that it is important to maintain professional competency through continuing

education training. This very high percentage is a clear indication of the value

AAASP members place on maintaining professional competency. Maintaining

professional competence through continuing professional education ensures that

the scholars and practitioners in the field of exercise psychology are providing the

most current services to their clients.

CULTURAL AND ETHNIC DIVERSITY

The ethical standards of the APA (2002) and the AAASP (1994) clearly indicate

the importance of recognizing that human differences such as age, gender, and ethnicity

do exist and can significantly impact a practitioner’s work. The standards

emphasize the responsibility to develop the skills required to be competent to work

with a specific population or to be able to make an appropriate referral. The importance

of understanding the culture and background of a variety of populations is vitally

important in both exercise and therapeutic settings.

Research indicates high rates of obesity and inactivity among women and minority

groups. About 33.4% of all women are obese, compared to 27.5% of men

(Goldsmith, 2004). The age-adjusted prevalence of overweight and obesity in racial/

ethnic minorities, especially minority women, is generally higher than in

Whites in the United States (Flegal, Carroll, Ogden, & Johnson, 2002). More specifically,

among women, non-Hispanic White women have the lowest occurrence

ETHICAL ISSUES IN EXERCISE PSYCHOLOGY 67

(30.7%) of obesity, non-Hispanic Black women have the highest (49.0%), and

Mexican American women are in the middle (38.4%; Hedley et al., 2004).

The importance of cultural sensitivity and awareness is clearly underscored by

the aforementioned data. Barriers to exercise adherence are often directly or indirectly

related to personal and cultural factors. Therefore, when working in the area

of exercise consulting, a practitioner needs to consider the impact, positive and

negative, of factors associated with gender, ethnicity, socioeconomic status, and

other potentially relevant culturally based factors.

In traditional counseling and clinical settings, the impact of factors associated

with gender, ethnicity, and culture is also highly relevant for successful outcomes.

In 1972, the Association of Multicultural Counseling and Development (AMCD),

was established to assist with recognizing the assets of culture and ethnicity, and

other social identities and to address concerns about ethical practice (Arredondo&

Toporek, 2004, p. 45). These factors are also pertinent for practitioners who desire

to include exercise as a component of treatment. A series of essential questions to

address prior to prescribing exercise as a therapeutic modality include: Is exercise

valued in the culture and/or by the client? What is the prior exercise history of the

client? What types of social support are available to assist the client with exercise

adherence? Does the client’s culture create any additional barriers for adherence

for exercise and traditional treatment?

MULTIPLE-ROLE RELATIONSHIPS

AND CONFLICTS OF INTEREST

Multiple-role relationships are often viewed as occurring when the therapeutic

connection has moved toward a friendship relationship (Bernstein & Hartsell,

2004). Multiple-role conflicts in therapy and consultations for exercise adherence

may be encountered when clear boundaries have not been established. When the

relationship boundary between the professional and client becomes clouded, the

likelihood of multiple-role conflicts greatly increases. Every practitioner needs to

maintain ethically proper professional boundaries. Establishing and maintaining

such boundaries can be difficult due to the casual atmosphere that surrounds the

exercise environment. The casual environment is created by the type of clothing

worn during exercise, music being played, and the social atmosphere of many exercise

and rehabilitation facilities.

A first step in maintaining appropriate boundaries is to establish a common protocol

when communicating with all new clients. Instead of using first names,

which seems to be a more common custom, it might be helpful to be consistent

with the practice of referring to clients by last name and title (Miss, Ms., Mrs., and

Mr. Brown). This practice encourages clients to maintain a distance from the

therapist.

68 PAULINE, PAULINE, JOHNSON, GAMBLE

Maintaining this distance becomes even more difficult when exercising with

clients. Exercising together can be a great vehicle for building rapport and developing

communication between practitioner and client. Conversely, exercising with

clients may cloud the boundaries and thus cause some confusion or ambiguity regarding

the nature of the relationship between client and practitioner. There are no

current guidelines and/or laws relative to this specific situation. However, both the

APA (2002) and AAASP (1994) ethic codes indicate that multiple roles can be inappropriate

and unethical if handled in the wrong way and need to be maintained

with great caution. Clarifying the nature of the relationship during the intake and

informed consent process, prior to exercising with the client, is of primary importance.

It is the practitioner’s ethical responsibility to have a candid discussion with

the client that clearly defines a therapeutic relationship and the limitations concerning

nontherapeutic personal contact. For example, personal contacts such as

engaging in recreational or competitive athletic teams, attending sporting events,

and other general social functions together are in violation of maintaining therapeutic

boundaries. The practitioner should have a clear rationale for prescribing

exercise in a client’s treatment plan. In addition, the rationale for exercising together

(i.e., to develop rapport) should be clearly communicated and understood

between practitioner and client.

When exercising with clients, a common dilemma the practitioner faces is determining

what type of physical activity should be implemented. As previously

mentioned, research has found a variety of activities (aerobic and anaerobic) that

provide physical and psychological benefits (USDHHS, 1996). In regard to adherence,

it is vital to have clients’ input concerning activity selection. When clients

have input into the selection process, they will likely select/choose a physical activity

they enjoy. Enjoyment of the activity has been positively correlated to adhering

and maintaining an exercise regimen (Wankel, 1993).

Walking is one of the most commonly reported types of physical activity

(USDHHS, 1996). Walking is an excellent choice of physical activity for numerous

reasons. First and foremost, many people are able to walk. Furthermore, the

risks associated with walking are minimal due to the low to moderate intensity

level. Also, most people are able to walk and talk simultaneously, which is necessary

for therapeutic consultations. Last, walking can be performed inside or outside

and requires minimal equipment or modification of clothing. For clients who

are able to and desire a more intensive level of activity, jogging is a viable alternative

to walking. When selecting jogging, a major requirement is for the therapist

and client to have a high level of cardiovascular fitness. A high level of cardiovascular

fitness allows them to talk with each other while exercising.

Anaerobic activities such as strength training provide clients and therapists

with another viable option for activity selection. During strength training, there is

ample time for communication and discussion between practitioner and client.

However, there are a few limiting factors when choosing strength training. Most

ETHICAL ISSUES IN EXERCISE PSYCHOLOGY 69

strength training activities require specialized equipment and facilities and present

increased potential for risk of injury. In addition, a couple of potential ethical dilemmas

when including strength training are competency and confidentiality. The

therapist may not have the knowledge base and/or experience to supervise a

strength training program that would accomplish desirable health and therapeutic

objectives. It may also be difficult to maintain confidentiality due to other people

exercising in very close proximity.

The mental health practitioner should not assume the role of a physician, exercise

physiologist, or personal trainer in terms of providing or modifying an exercise

prescription. Furthermore, practitioners should be cognizant of their primary

role, which is to assist with exercise adherence and consultation. Exercise psychology

practitioners ethically need to be aware of their professional limitations and

competence boundaries vis-à-vis their education and training.

Maintaining an appropriate distance is sometimes useful in diverting inappropriate

attempts at amorous and other nonprofessional relationships. Sexualizing

the relationship with a client is clearly unethical as well as very unsound professional

practice that harms both the client and practitioner (APA, 2002; AAASP,

1994). Practitioners often hold an advantage of power over the people with whom

they work. Furthermore, practitioners occupy a position of trust and are expected

to advocate the welfare of those who depend on them.

Physical contact within the counseling and exercise setting is often ethically appropriate.

However, contact that is intended to express emotional support, reassurance,

or an initial greeting can be misinterpreted as an invitation for advances. The

social environment, revealing clothes, and close proximity that surround the exercise

setting can lead to inappropriate advances by clients or practitioners. Recognition

of signs, both in clients and in therapists, and dealing with these feelings immediately

and objectively is the best approach. The practitioner should discuss these

feelings with an experienced, respected, and trusted colleague. If the practitioner is

unable to control his or her feelings, termination and referral are recommended as a

method of protecting both the client and practitioner.However, on termination of the

relationship, thetwoindividuals are not ethically “free” to pursue amoresocial or intimate

relationship. It is strongly suggested to have a cooling off period (several

monthsto years) inwhichboth parties agree towait prior to pursuing a relationship at

a different level.Amore conservative approach suggested by Bernstein and Hartsell

(2004) is to followthe belief ofoncea client, always a client.With the adoption of this

approach, once a professional relationship is initiated it must always be maintained,

thus reducing the notion or intention of modifying any professional relationship.

DEPENDENCY ON THE THERAPIST

Another issue that must be discussed in collaboration with multiple-role relationships

is a client’s level of dependency on a therapist’s services and influence.With-

70 PAULINE, PAULINE, JOHNSON, GAMBLE

out question, as human beings we live in a world where dependency on others is

crucial to an individual’s survival. Memmi (1984) explained that the level of dependence

on others should be presented from three perspectives: “1) according to

the identity of the dependent (e.g., child, adult), 2) to that of the provider (e.g., human

being, animal, or object), and 3) to the object provided (e.g., winning a medal

versus establishing a friendship)” (p. 18). For example, children (dependent) rely

on their caregivers (provider) for acquiring and supplying food, water, and shelter

(objects provided) to survive within our society. Therefore, as children develop

into adults, they must acquire the knowledge and skills from a caregiver to successfully

gain the necessities to survive independently. Similarly, clients attend counseling

sessions in hopes of gaining the appropriate knowledge and skills so they

can effectively cope with issues that currently disrupt their quality of life.

Another view of examining the level of a client’s dependence on a therapist is

intertwined within attachment theory. “John Bowlby’s attachment theory is based

on an attachment behavioral system—a homeostatic process that regulates infant

proximity-seeking and contact-maintaining behaviors with one or few specific individuals

who provide physical or psychological safety or security” (Sperling &

Berman, 1994, p. 5). Bowlby (1980) indicated that the level of continuity, which is

a key component of attachment theory, is the way children construct attachment

behaviors into a strategy for relating with others and how these behaviors greatly

influence succeeding behaviors across the life span. An individual’s attachment

behavioral system can become activated through various activities and events, including

stressful periods (Sperling & Berman, 1994). Interestingly, a therapeutic

relationship has the potential for activating an adult client’s attachment expectations

and behaviors (Bowlby, 1988; Woodhouse, Schlosser, Crook, Ligiero, &

Gelso, 2003).

As previously stated, it is important to realize that individuals who seek therapeutic

services are usually attempting to alter their behaviors and/or emotions to

manage problems interfering with their daily lives. In other words, clients may

seek the services of mental health professionals because they believe therapists

have the ability and knowledge to provide care, comfort, and guidance to relieve

their debilitating issues (Bowlby, 1988; Farber, Lippert, & Nevas, 1995; Riggs,

Jacobvitz, & Hazen, 2002; Slade, 1999).

Specifically, within the realm of exercise psychology, individuals may solicit

a therapist for psychological services to assist in the quest of achieving their desired

outcomes (e.g., losing weight, increasing their levels of physical activity,

mood alteration). During these counseling sessions, clients may complete physical

activities (e.g., walking, jogging, strength training) with their therapist. Some

therapists believe conducting therapy while exercising with their clients is beneficial

to the overall treatment plan and objectives (Hays, 1999). For example,

mental health practitioners can monitor clients’ behavioral and emotional states

while completing the physical activities together. During these physical activities,

a therapist gains an immediate perception of how the client is progressing

ETHICAL ISSUES IN EXERCISE PSYCHOLOGY 71

with the assigned tasks. Therefore, alterations to the treatment plan can be introduced

while exercising.

As clients accomplish their goals (e.g., losing the desired amount of weight, increasing

the level of physical activity, mood alteration), it is probable that they will

develop a new identity and/or level of self-worth (e.g., confidence, esteem). Numerous

research investigations indicate that an increase in the level of physical activity

will improve individuals’ mental well-being and decrease numerous health

risks (e.g., cardiovascular disease, cancer; USDHHS, 1996).

Unfortunately, the realization of clients’ desired outcomes (e.g., loss of weight,

positive self-image, mood alteration) potentially could produce an increased level

of dependence (i.e., attachment) on the therapist and services provided. That is, clients

may develop the notion that the therapeutic relationship with their exercise

practitioner must continue to achieve and maintain the desired outcomes. Dishman

(1988) explained adherence to exercise (i.e., physical activity) can be difficult, as

up to 50% of exercisers drop out within the first 6 months of initiating an exercise

program. This may be a reason why some individuals who maintain an exercise

regimen become dependent on the services provided by fitness trainers. For example,

certain individuals are unwilling to work out alone or require motivation, social

support, and guidance from a fitness trainer to complete physical activities and

pursue their physical fitness goals. Thus, a level of dependence is established, and

possibly strengthened, as the individual continues an exercise routine under the supervision

of a fitness trainer. Despite the lack of research, a similar level of dependence

for a client may develop during a therapeutic relationship with an exercise

therapist. To date, no research investigations have examined the level of clients’dependence

on their exercise therapist. However, “exercising with clients during

therapy could promote dependency” (Hays, 1999, p. 61). Therefore, exercise practitioners

should be aware that clients’ level of dependency may become an issue

even if the sessions produce the desired healthy outcomes.

CONFIDENTIALITY AND RECORD KEEPING

Confidentiality is another central ethical issue that often arises in a variety of traditional

and exercise counseling settings. Confidentiality is directly addressed in

both the APA (2002) and AAASP (1994) ethics codes of conduct. Standard 4.01 of

the APA (2002) ethics code states that practitioners “have a primary obligation and

take reasonable precautions to protect confidential information obtained through

or stored in any medium, recognizing that the extent and limits of confidentiality

may be regulated by law or established by institutional rules or scientific relationship”

(p. 7). Clients value privacy, and it is not uncommon for a client to begin

an initial interview by asking about confidentiality (Zaro, Barach, Nedelman, &

Dreiblatt, 1994). Because the limits of confidentiality differ from state to state, it is

72 PAULINE, PAULINE, JOHNSON, GAMBLE

essential to learn the specifics in your own area. Presented in the following paragraphs

are some general recommendations for maintaining confidentiality across a

variety of activities as they relate to exercise consultations.

Within the dynamic of exercise consultations it is common to collaborate with a

variety of professionals (e.g., physicians, trainers, exercise physiologists, dieticians).

Collaboration with colleagues is an important means of ensuring and maintaining

the competence of one’swork and the ethical conduct of psychology. When

consulting with colleagues, one should not disclose confidential information that

reasonably could lead to the identification of a client. Even when prior consent has

been granted by the client, the disclosure of information should be only to the extent

necessary to achieve the purposes of the consultation. Maintaining confidentiality

and respect for the client’s privacy should be upheld at all times and is vital in

maintaining a collaborative and trusting relationship with clients.

When using the Internet or other sources of electronic media, it is the practitioner’s

responsibility to become knowledgeable about employing appropriate methods

for protecting the confidentiality of records concerning clients (Fisher, 2003).

The Internet and other electronic media are vulnerable to breaches in confidentiality

that may be beyond an individual’s control. For example, when personal files or

therapy notes are stored on a common server or university system server, security

measures such as the use of password protection and firewall techniques should be

in place. Conducting assessments, exercise adherence, or traditional counseling

via e-mail, secure chat rooms, cell phone, or providing services on a Web site are

all mediums in which confidentiality can be violated. Clients should be informed

of the risks to privacy and limitations of protection when utilizing an electronic

medium to deliver exercise consultation services. Similarly, safeguards should

also be used for handwritten therapy notes, treatment plans, or client records.

These types of records and documents should be stored in locked file cabinets.

ADVERTISEMENT AND SELF-PROMOTION

Most individuals do not become involved in the field of psychology—whether it is

general, clinical, sport, or exercise psychology—due to their abilities for selfpromotion.

However, these skills become important when trying to increase one’s

exposure and attracting potential clients.Without development or training in ethical

marketing or self-promotion, it is quite common for the issues pertaining to

self-promotion and marketing to be discomforting (Heil, Sagal,&Nideffer, 1997).

The APA (2002) ethics code (Ethical Standard 5) addresses advertising and

other public statements more thoroughly than does the AAASP (1994) ethics code

(i.e., General Ethical Standard 16). Clearly identifying one’s credentials or certifications

is the first step in understanding the process of advertising and public statements.

It is the professionals’ responsibility to appropriately identify their creden-

ETHICAL ISSUES IN EXERCISE PSYCHOLOGY 73

tials and take the initiative to correct misrepresentations when mistakes are made.

In addition, it is unethical to solicit testimonials from current clients or other influential

individuals due to their position, title, or status. For example, Dr. White prescribes

exercise as a component of counseling for a famous actress. She attains her

desired therapeutic goals through proper exercise adherence and counseling.

Based on this scenario, it is unethical for Dr. White to solicit a testimonial from the

actress promoting the benefits of his counseling.

There are ethical and appropriate methods of enhancing one’s visibility. These

methods include, but are not limited to, speaking at various rehabilitation clinics,

exercise facilities, and civic organizations. Providing information through speaking

engagements about the nature and benefits of exercise psychology and adherence

counseling will be professionally beneficial by creating the opportunity for

practitioners to integrate and synthesize theories and research findings into practice

for their specific audience. Another vehicle to enhance exposure is through

public interviews with local radio, television, and newspapers. The establishment

of aWeb site is another possible source of exposure. Speaking engagements, interviews,

and the development of a Web site are excellent methods of “getting your

name out there,” but there is no guarantee that these methods will lead to clients

and referrals.

The development of a client and referral base is an ongoing challenge. However,

the practitioner who is able to interact with colleagues from various settings

(e.g., physicians, athletic trainers, physical therapists, personal trainers, exercise

physiologists, and other mental health professionals) will have an advantage in developing

a wide range of referral sources. Furthermore, there is no substitute for

word-of-mouth referrals. This means those practitioners who develop an effective

working relationship and provide effective strategies to assist their clientele in

reaching their desired goals will be able to maintain and expand their client list.

FUTURE ISSUES AND OPPORTUNITIES

Issues related to the most desirable qualifications for the exercise psychologist or

consultant will continue to be debated. However, it appears that interdisciplinary

training is vital and will positively contribute to the development of collaborative

and effective professionals within the field of exercise psychology. A movement

toward accreditation of programs also adds to the establishment of quality training

for future professionals.

Employment in the field of exercise psychology and consulting, which bridges

the areas of psychology and movement sciences, can provide a challenging and rewarding

career.Within the challenges lie numerous ethical considerations and behaviors

that should be clearly conceptualized prior to and while involved in this

emerging field. The previous discussion of potential ethical issues and dilemmas is

74 PAULINE, PAULINE, JOHNSON, GAMBLE

by no means a complete guide. This article is just a starting point for future dialog

regarding ethical issues related to exercise psychology and consulting.

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Arredondo, P., & Toporek, R. (2004). Multicultural counseling competencies = ethical practice. Journal

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Association for the Advancement of Applied Sport Psychology. (1994). Ethical principles and standards.

Retrieved February 21, 2005, from http://www.aaasponline.org/ethics.html

Berger, B., Pargman, D., & Weinberg, R. (2002). Foundations of exercise psychology. Morgantown,

WV: Fitness Information Technology.

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Hoboken, NJ: Wiley.

Bickham, A. (1998). The infusion/utilization of critical thinking skills in professional practice. In W.

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Dishman, R. (1988). Exercise adherence: Its impact on health. Champaign, IL: Human Kinetics.

Etzel, E.,Watson, J., & Zizzi, S. (2004). AWeb-based survey of AAASP members’ ethical beliefs and

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Farber, B., Lippert, R., & Nevas, D. (1995). The therapist as an attachment figure. Psychotherapy, 32,

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Fisher, C. (2003). Decoding the ethics code: A practical guide for psychologists. Thousand Oaks, CA:

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Hays, K. (1999).Working it out: Using exercise in psychotherapy.Washington, DC: American Psychological

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York: Cambridge University Press.

Report Issue

For this assignment you will complete the Introduction portion of your paper.  The Introduction should be about one page in length and will respond to two critical questions asked by ALL researchers in ALL research efforts.  Those questions are:
1.   WHY did the authors of your article – the researchers – decide to do this research?  WHAT was the research question (or questions) they asked (their HYPOTHESIS)?  You must be VERY SPECIFIC in responding to this first question because the rest of your paper will hinge on it.

2.  HOW did the researchers approach their research …what METHOD of research did they use?  Did they conduct a true experiment?  A correlational research design?  A longitudinal design?  WHAT?  More often than not, these two questions will be answered in the Abstract of your article.  If they are not, read their Introduction and Methods sections and the answers will be there.  Tell me WHY the authors decided to use this particular method of research.

Journal: Addressing Conflict

Addressing conflict takes strategy and skill. In Week 6, you completed the “Types of Leadership and Patterns of Management” interactive graphic in order to get a sense of your leadership style. Your leadership style influences the way you make decisions and use strategies to address conflict. For example, if your leadership style emphasizes motivation, you are likely to employ motivation to work with staff and address conflict. How you address conflict provides insight into how you might execute your role as a human services administrator.

For this Journal Assignment, select an organization with which you are associated or one with which you are familiar. Revisit the “Types of Leadership and Patterns of Management” tool you completed in Week 6. Think about how your leadership style would influence how you might address conflict in the organization you selected.

Post in your Journal a step-by-step conflict management agreement or policy that you would want to have in an organization where you are the person in authority to implement a policy. Include a step-by-step strategy for what employees and volunteers should do if they get into a dispute in order for it to be resolved.

Suggested length: approximately 250–500 words (1–2 pages).

Argumentative Essay

In the Week 3 Assignment, you engaged in a case analysis of a current business problem using some of the components of an argumentative essay. In this written assignment, you will write a complete argumentative essay as described in Sections 9.1 and 9.2 of With Good Reason: A Guide to Critical Thinking (Foster, Hardy, & Zúñiga y Postigo, 2015). This essay will include a revised and polished version of your Week 3 Assignment, an objection to your thesis, a rebuttal, and concluding remarks. In order to benefit the most, you should start working on your Final Project from the time you receive your Week 3 Assignment back with comments from your professor.

Your assignment should include the following:
A revision of your Week 3 Case Analysis Assignment. Your revision should represent a substantial edit of your work that fully incorporates feedback from your professor and goes well beyond correcting any grammatical or APA errors.

The strongest possible objection to your thesis. After the final paragraph of your Week 3 Case Analysis Assignment, start a new paragraph that introduces the strongest possible objection to your thesis. The considerations for this are detailed in Section 9.2 of With Good Reason: A Guide to Critical Thinking (Hardy, Foster, & Zúñiga y Postigo, 2015). Make sure to employ the appropriate language to introduce the objection, such as “some may object to my thesis as follows” or “according to [so and so] the thesis presented here fails to account for X” [whatever he or she finds problematic]. You can find other language to do this, of course, but the key point here is to make sure that you indicate that someone else is speaking when presenting this objection.

It is also important to remember that you do research to discover good objections and not merely objections that are weak and thus easily rebutted. Look for peer-reviewed journal articles in the Ashford University Library, full-text articles in Google Scholar, or articles in the Stanford Encyclopedia of Philosophy. Present the opposing position fairly and in detail. This may take more than one paragraph.

A rebuttal. This is a refutation of the objection that you have just presented. Start this in a new paragraph following the objection paragraph(s). Once again, follow the indications of Section 9.2 of With Good Reason: A Guide to Critical Thinking (Hardy, Foster, & Zúñiga y Postigo, 2015). You may point out an error in the objection. Or you may show that, while it is an important objection, it does not apply squarely to your argument, or does not account for facts that make it irrelevant. Above all, make sure to maintain philosophical decorum in your rebuttal. Toward this end, you should apply the principles of charity and of accuracy, first introduced in the Week 1 course material. See “Confronting Disagreement” in Section 9.4 of With Good Reason: A Guide to Critical Thinking (Hardy, Foster, & Zúñiga y Postigo, 2015).

Closing remarks. End your argumentative essay with a paragraph of closing remarks. Provide some reflections of what you have attempted to achieve by means of your essay. You could, for example, explain how your essay sheds light on the broader controversy that it addresses. Or you could point out how your essay addresses a frequently ignored point or the unpopular side in the controversy. You could also reflect on the related matters in the broader controversy that would be useful to examine by others. Do not merely summarize what you have done in the body of your essay, and do not add new information here that would support or contradict your essay since the body of your essay should have addressed all the relevant points. See “Closing Your Essay” in Section 9.2 of With Good Reason: A Guide to Critical Thinking (Hardy, Foster, & Zúñiga y Postigo (2015).

Requirements for your Assignment:

• Your assignment should be between 1500 to 1700 words in length, excluding the cover and references pages.
• Your examination should be both thorough and succinct. This is a combination that demands time and thought, so give yourself sufficient time to draft and revise.
• Your assignment should include citations, as well as a list of references. Both must be in APA form.
• Your references should include at least four peer-reviewed articles in addition to those that you will be carrying over from our Week 3 Case Analysis Assignment. These references should be drawn from the Ashford University Library, Google Scholar, or the Stanford Encyclopedia of Philosophy.

Which of the following is NOT true about Fundamental Attribution Errors?

they are judgments we make about others based on their group membership

they are typically error prone

they result in discrimination

they always consider the situation and have nothing to do with group membership

Question 2

When we make a personal attribution about someone’s behavior – we are believing their actions are due to the person’s…

effort or lack of effort

deliberate intention

personal disposition

all of the answers are correct

Question 3

A teacher believes that the reason his female student received a poor grade is because she lacked ability. But the teacher also believes that the reason his male student did poorly was because of problems he is experiencing at home. In this example, the teacher is making a….

correct decision

personal attribution

situational attribution

fundamental attribution error

Question 4

When making a situational attribution about someone’s behavior, we believe that his/her actions were due to….

their effort

something beyond their control

their personal disposition

deliberate intention

Question 5

A supervisor believes his employee is lazy and unmotivated because he called in sick. In this example, the supervisor is making a…

none of the responses are correct

situational attribution

personal attribution

fundamental attribution error

Please no plagiarism and make sure you are able to access all resource on your own before you bid. One of the references must come from Flamez, B. & Sheperis, C. J. (2015) and/or Sommers-Flanagan, J., & Sommers-Flanagan, R. (2007). You need to have scholarly support for any claim of fact or recommendation regarding treatment. APA format also requires headings. Use the prompt each week to guide your heading titles and organize the content of your initial post under the appropriate headings. Remember to use scholarly research from peer-reviewed articles that is current. I have also attached my discussion rubric so you can see how to make full points. Please follow the instructions to get full credit for the discussion. I need this completed by 02/05/19 at 6pm.

Discussion – Week 11

Impact on Family Functioning

There are multiple types of exceptionalities with some being more severe than others. For example, Down syndrome and cerebral palsy are types of exceptionalities that affect the cognitive, behavioral, and physical functioning of a child or adolescent. Children and adolescents with learning disorders and pervasive disorders such as autism or Asperger’s disorder may have difficulty with social interactions and often require academic remediation. No matter the exceptionality, it can have a dramatic impact on family functioning. For example, stress levels can increase between spouses, the physical demands of caring for children and adolescents with exceptionalities can be exhausting, and managing difficult behaviors of a child or adolescent can take a toll on all members of a family. Parents may feel guilt, remorse, sadness, and grief over having a child with an exceptionality.

If you plan to work with children or adolescents with exceptionalities, you must have a firm understanding of the various types of exceptionalities so you can understand the needs of the child and adolescent. It also provides you an understanding of the needs of the family so you can develop and implement effective interventions. Keep in mind when working with parents of children with exceptionalities, that while they generally love their children, it can be challenging to care for them and you must help the parents feel supported and free of judgment.

For this Discussion, search the Walden Library, current literature, and reputable sources on the Internet and select a journal article researching a type of exceptionality. Consider the impact the exceptionality may have on a family. Reflect upon whether a female or male child might impact the family functioning differently. Consider what type of intervention and support you might provide the family to improve family functioning.

With these thoughts in mind:

Post by Day 4 a brief description of the exceptionality you selected. Then, explain two ways the exceptionality may impact family functioning and how. Finally, explain one therapeutic intervention you might use to improve family functioning. Be specific and support your response using the article you selected.

Be sure to support your postings and responses with specific references to the Learning Resources.

Bottom of Form

Required Resources

Readings

· Flamez, B. & Sheperis, C. J. (2015). Diagnosing and treating children and adolescents: A guide for clinical and school settings. Hoboken, NJ: John Wiley & Sons, Inc.

• Chapter 5 “Autism Spectrum Disorder”
• Ali, M. M., Salleh, N. M.      (2008). Similar of different? Examining views on exceptionality among      individuals with and without special needs. International Journal of Diversity in Organizations,      Communities, and Nations, 7(6), 335–342.
  Retrieved from the Walden Library databases.
• Estell, D. B., Farmer, T. W.,      Irvin, M. J., Crowther, A., Akos, P., & Boudah, D. J. (2009). Students with      exceptionalities and the peer group context of bullying and victimization      in late elementary school  . Journal of Child and      Family Studies, 18(2), 136–150.
  © 2009 by HUMAN SCIENCES PRESS. Reprinted by permission of      HUMAN SCIENCES PRESS via the Copyright Clearance Center.
• Orfus, M., & Howe, N.      (2008). Stress appraisal and coping in siblings of children with special      needs. Exceptionality Education Canada, 18(3),      166–181.
  Retrieved from the Walden Library databases.
• Xiong, N., Yang, L., Yu, Y.,      Hou, J., Li, J., Li, Y., Liu, H., Zhang, Y., & Jiao, Z. (2011). Investigation of raising      burden of children with autism, physical disability and mental disability      in China  . Research in      Developmental Disabilities: A Multidisciplinary Journal, 32(1),      306–311.
  © 2011 by ELSEVIER SCIENCE & TECHNOLOGY JOURNALS.      Reprinted by permission of ELSEVIER SCIENCE & TECHNOLOGY JOURNALS via      the Copyright Clearance Center.
• DSM-5 Bridge Document: Exceptionalities 

Optional Resources

• Rose, C. A., Espelage, D. L.,      Aragon, S. R., & Elliot, J. (2011). Bullying and victimization among      students in special education and general education curricula. Exceptionality Education International, 21(3),      2–14.
  Retrieved from the Walden Library databases.
• Roskam, I., Zech, E., Nils, F.,      & Nader-Grosbois, N. (2008). School reorientation of children with      disabilities: A stressful life event challenging parental cognitive and      behavioral adjustment. Journal of Counseling & Development, 86(2),      132–142.
  Retrieved from the Walden Library databases.
• Woods, A. G., Mahdavi, E.,      & Ryan, J. P. (2013). Treating clients with Asperger’s and      autism. Child & Adolescent Psychiatry &      Mental Health, 7(1), 1–8.
  Retrieved from the Walden Library databases.