Diana Jochai


The current study examined a new conceptual model of factors critical to a therapist’s decision-making process when faced with the potential of a nonsexual multiple relationship with a client. This new model was founded on the conceptual framework proposed by Street, Douglas, Geiger, & Martinko (2001) and integrated the components of the decision-making process and the individual and situational factors influencing those components identified in existing general conceptual models and specific behavioral guidelines. For the ethical decision-making process to begin, a practitioner must be able to recognize the presenting problem as an ethical dilemma (Brazerman, 1986; Jones, 1991; Street et al., 2001; Zur, 2007). Street et al. proposed that the degree to which an individual will expend cognitive effort (i.e., the level of cognitive expenditure) to recognize (as well as think through and make a decision about) an ethical dilemma is dependent on both motivation and ability elements. In turn, there are individual and situational characteristics that impact both the individual’s motivation and ability. As such, this study was intended to explore the role of the practitioners’ individual motivation element (affective response to the problematic situation, need for cognition, need for closure or tolerance of ambiguity, and gender) and ability (i.e. “ethical sensitivity”) element (e.g., type of ethics training, experience as a clinician, knowledge of the current Ethics Code [APA, 2002], and empathy) in their willingness to expend cognitive energy to recognize an ethical dilemma involving a potential nonsexual multiple relationship. It was predicted that the greater the degree of cognitive expenditure, the greater the likelihood that the psychologist would recognize the ethical dilemma. Both motivational and ability elements in this study were hypothesized to be related to the likelihood of recognition of an ethical dilemma by impacting the level of cognitive expenditure. Eighty five clinical psychologists completed the Positive and Negative Affect Schedule (PANAS) (Watson, Clark, & Tellegan, 1988), Need for Cognition Scale (NCS) (Cacioppo, Petty, & Kao, 1984), Multiple Stimulus Types of Ambiguity Tolerance (MSTAT-I) (McLain, 1993), Interpersonal Reactivity Index (IRI) (Davis, 1983), Ethical Knowledge Questionnaire, and a demographic questionnaire that assessed the gender, the nonsexual multiple relationship ethics, event occurrence (scenario) ethics training, and experience as a clinician. Data attained from these measures was analyzed using factor analyses, as well as linear and multiple regression. The proposed model was not supported by the data; however, this study generated a number of important findings. Individual motivation element was found to consist of two subfactors: a cognitive one (need for cognition and need for closure) and an affective one (positive affect). “Ethical sensitivity” seemed to compose more characteristics than those included in the individual ability element; it was also captured in the individual motivation element. One of the cognitive characteristics, the need for cognition, and positive affect were found to correlate significantly with cognitive expenditure. Positive affect was the only significant predictor of cognitive expenditure; thus, individual’s positive emotion appeared to have the strongest potential to be beneficial or impinging to the cognitive process when engaging in decision-making process. The findings showed that the likelihood of recognition of an ethical dilemma related to gender of the therapist and his or her level of empathy; “moral intensity” of the dilemma seemed to be a potential determining factor on which of these characteristics served as the strongest predictor. Further research is needed to explore the role of “moral intensity” in recognition of the ethical dilemma. Although further refinement of the measure of cognitive expenditure is required, the results showed this component to form a curvilinear relationship with recognition of ethical dilemma with low level of cognitive expenditure related to both lower and higher likelihood of recognition of an ethical dilemma. High cognitive expenditure associated with moderate scores of recognition of ethical dilemma. Limitations and future directions were offered as well as the implications for clinical training.

LLU Discipline



Clinical Psychology


Graduate Studies

First Advisor

Janet Sonne

Second Advisor

Kelly R. Morton

Third Advisor

David Vermeersch

Degree Name

Master of Arts (MA)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Psychotherapist and patient -- Moral and ethical aspects; Decision making -- Moral and ethical aspects; Psychotherapists -- Professional ethics; Interpersonal relations; Professional-Patient Relations -- ethics -- dissertations; Decision Making -- ethics; Ethics, Medical; Professional Misconduct.



Page Count

xiii; 121

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website


Loma Linda University. Del E. Webb Memorial Library. University Archives