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JCPSLP Volume 19, Number 2 2017 105
Ethical conversations
Susan Block
ultimately what I really value is my independence and this
combination affords me greatest control over my
professional experience. I do not end up doing the parts of
an academic role about which I may not be passionate
(e.g., some aspects of teaching, administration!). However,
a negative of private practice is that the role of a private
practice – to provide quality therapy to those who request
and who would benefit from it –can sometimes be in
conflict with that of a research clinician. For example, if
interested in a project on preschool stuttering, the project
criteria might stipulate that the children have stuttered for a
certain amount of time, but my clinical experience might
suggest that some of these children would benefit from
earlier commencement of treatment. Thus, at times there is
potential for conflict.
Another key tension in private practice is that a private
practice needs to be sustainable financially, whereas
sometimes conducting research ethically means it is not
possible to charge for a treatment, thus there is no income
generated from that client contact.
How do you determine your projects?
Often in collaboration with a team at another university;
sometimes from a clinical question that has come up from my
clinical experience, or a query from the literature. For example,
the Lidcombe Program treatment literature shows that
parents can find it a stressful experience to administer the
Lidcombe Program and I have found this in my practice. As
a result, I am evaluating the impact of a support group for
parents whose children are doing the Lidcombe Program.
To whom do you apply for ethics
approval?
This is a key reason for needing to collaborate with a university
or relevant body. Research with human participants requires
ethics approval
human-research-ethics-committees-hrecs) and journals
require evidence of this to publish outcomes. The process
can be quite complicated so it is good to work with someone
who has experience of the paperwork and the process. It also
ensures we do the right thing by our clients/participants.
Have you met any conflicts of
interest or ethical problems in your
research and clinical practice?
One potential conflict is retaining client participants for the
entirety of the clinical trial in private practice, when the
In an attempt to demonstrate how clinicians can integrate
ethical practice, clinical research and clinical practice in a
private practice setting, Dr Brenda Carey has graciously
agreed to describe her experiences. Dr Carey has many
facets to her work. She completed her PhD while managing
an RCT comparing face-to-face and telehealth delivered
treatment for adults who stutter. She has an honorary
affiliation with the Australian Stuttering Research Centre at
Sydney University, is a clinical supervisor at La Trobe
University, a member of the Lidcombe Program and Camper­
down Program Trainers Consortia, and runs a successful
private practice in Melbourne. Brenda was interviewed by
Dr Susan Block, Senior Member, SPA Ethics Board.
How have you managed to blend
private practice and research?
I managed to link in with university research programs and
have been employed by, or collaborated with several
universities. That has great benefits – it enabled me to
choose what projects to be involved with. The combination
of workplaces is really interesting. To have the opportunity
to research your “most real” participants (your clients)
means sampling from an ecologically valid group. On the
other hand, I think not working in academia also brings a
cost because I believe that really interesting research
comes from really interesting ideas, and working with
people directly involved in research as their primary focus in
academia may be more likely to generate interesting ideas.
So does that mean that you get
added intellectual stimulation from
your university contact?
Yes, as a clinician in private practice I see the practical
application of research; but the negative is not being a part of
a think tank that is integral to the best academic environments.
The other negative is that I do not have ready access to funding
from within my workplace or the support mechanisms to do
research. Another negative of not working within a research
team at a university is less experience in designing research
projects, writing and publishing. I consider it far better to
have access to a team with experience in all these processes.
Why have you continued in private
practice and not academia, which
is more set up for research?
This is an issue that I continually grapple with as I enjoy
both, and both have very strong positives. However,
Ethics in clinical
practice
An interview with Dr Brenda Carey, clinician researcher
Susan Block