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Ethics ch8
Boundary Issues
15
Psychology
Graduate
07/10/2013

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Cards

Term
CH8 INTRODUCTION
Definition

Boundaries

  • a frame around the therapeutic dyad that define a set of roles for participant in the clg relationship
  • help us to understand the parameters of the clg relationship
  • the clg relationship is a professional one & has certain limits that do not apply to a personal relationship
  • ex. there are no physical contact betw clr & clt, on time & place for clg, on amount & types of self-disclosure made by clr, & on the exchange of gifts
  • boundaries help provide structure to the clg relationship; its a limit that promote integrity
  • they serve to protect the clts welfare who are in vulnerable positions in that relationship

Dual or multiple relationships

  • occur when clrs  take on 2  or more roles sequentially with a clt
  • occur whenever clrs have another significantly different relationship with 1 of their clts, students, supervisees
  • can involve combining the clr's role with another professional relationship as teacher, minister, employer or with a personal relationship-friend, relative
Term
ACA CODE ON DUAL RELATIONSHIPS
Definition

A.5.a. Current Clients

  • Sexual or romantic counselor–client interactions or relationships with current clients, their romantic partners, or their family members are prohibited.

A.5.b. Former Clients

  • Sexual or romantic counselor–client interactions or relationships with former clients, their romantic partners, or their family members are prohibited for a period of 5 years following the last professional contact.
  • Counselors, before engaging in sexual or romantic interactions or relationships with clients, their romantic partners, or client family members after 5 years following the last professional contact, demonstrate forethought and document (in written form) whether the interactions or relationship can be viewed as exploitive in some way and/or whether there is still potential to harm the former client; in cases of potential exploitation and/or harm, the counselor avoids entering such an interaction or relationship.
Term
ACA CODE ON DUAL RELATIONSHIPS
Definition

A.5.c. Nonprofessional Interactions or Relationships (Other Than

Sexual or Romantic Interactions or Relationships)

  • Counselor–client nonprofessional relationships with clients, former clients, their romantic partners, or their family members should be avoided, except when the interaction is potentially beneficial to the client. (See A.5.d.)

A.5.d. Potentially Beneficial Interactions

  • When a counselor–client nonprofessional interaction with a client or former client may be potentially beneficial to the client or former client, the counselor must document in case records, prior to the interaction (when feasible), the rationale for such an interaction, the potential benefit, and anticipated consequences for the client or former client and other individuals significantly involved with the client or former client. Such interactions should be initiated with appropriate client consent.
  • Where unintentional harm occurs to the client or former client, or to an individual significantly involved with the client or former client, due to the nonprofessional interaction, the counselor must show evidence of an attempt to remedy such harm.
  • Examples of potentially beneficial interactions include, but are not limited to, attending a formal ceremony (e.g., a wedding/commitment ceremony or graduation); purchasing a service or product provided by a client or former client (excepting unrestricted bartering); hospital visits to an ill family member; mutual membership in a professional association, organization, or community.(See A.5.c.)
Term
THE COMPLEXITIES OF DUAL RELATIONSHIPS
Definition

4 characteristics of dual relationships that make them problematic for clrs

  1. potential dual relationships can be difficult to recognize-they can evolve in sublte ways.there are no danger or warning signs that marks the point at which a professional relationship is crossed into a behavior that could lead to an inappropriate relationship
  2. the potential outcome of dual relating ranges along a wide continuum from extremely harmful  to benign or beneficial to clts ex. clr who enters a sexual relationship with clt vs clr who attends a graduation ceremony
Term
THE COMPLEXITIES OF DUAL RELATIONSHIPS
Definition
  • #3 with the exception of sexual dual relationships, there is very little consensus among the professionals regarding the propriety of dual relationships - its not dual relating create the ethical problem but clr's personal tendency to exploit clts & misuse of power
  • #4 some dual relationships are unavoidable-clrs in isolated communities or very small towns may find it impossible to avoid some overlapping roles & may find it more difficult to maintain clear boundaries

Other small worlds

  • clrs who work in the military face many challenges.
  • people wih political affiliations, ethnic identities, & subtance dependence can also lead to dual relationships
  • pastoral clrs have overlapping relationships as some clts are members of th congregation-they face some unique boundary issues
  • lgbt clrs may find it impossible to participate in many political & social activities in the gay community without encountering their clts
  • substance & HIV clrs face similar issues
  • some cultural factors can reate small world dilemmas-Vietnamese clr goes home to counsel his people. many drew to him/her b/c they know he/she knows their cultural values-some clts maybe relatives
Term
RISKS & BENEFITS OF DUAL/MULTIPLE RELATIONSHIPS
Definition
  • clrs have to weigh the potential risk/harm & benefits to their clts

The potential for harm

  • loss of objectivity & power differential betw clr & clt makes it impossible to give true equal consent o extra professional relationship
  • it is possible clrs may unintentionally  or unconsciously exploit or harm clts who are vulnerable
  • 3 factors to consider in determining the risk of harm in nonprofessional relationship-incompatible expectations, divergent responsibilities, power differential
  • incompatible expectations - when E the employee expects her Supervisor to be more sympathetic as her clr/supervr
  • divergent responsibilities - C took the role of E's clr, she needed to be accepting & support but she was also her supervisor & have the right to evaluate her employees & do it accurately
  • there is a power differential - in their relationship C the supervisor & person of power, E the employee who made herself vulnerable by revealing her personal problems. C's professional responsibility is to avoid misusing her power & to ensure the more vulnerable person iss not harmed
  • when others-friends, relatives seek counsel - clr may listen as a friend, or may refer to another clr
Term
POTENTIAL BENEFITS TO CLIENTS
Definition

 

rationales in favor of dual relationships

  • when clrsactively maintain interpersonal distance, they unnecessarily emphatize the power differential & promote an objectification of the terapeutic relationship
  • dual relationships invites greater authenticity & congruence from clrs & can improve their professional judgment b/c DR make it more difficult for them to hide behind the protection of a professional mask
  • rigid adherence to boundaries can weaken therapeutic alliance & rigidity, aloofness, distance are in direct conflict with clr
Term
BOUNDARY CROSSINGS VS VIOLATIONS
Definition
  • clrs may engage  in some behaviors with clts often that have potential for creating dual relationships but are not-these are boundary crossings
  • BC - it is a departure from commonly accepted practice that occurs to benefit a clt - the boundary is shifted to mmet th particular needs of a clt at a particular moment
  • ex. clr who attends the graduation ceremony - clr's action is not a DR but has the potential to enhance the clg relationship
  • BV - if the BC patterns begin to blur the professional boundaries-the slippery slope phenomenon gradual erosion of clg relationship can lead to harm to clts & ethical violations

Legal Perspective on BC

  • clrs who violate their boundaries may face peer complaints against them & have to defend themselves before ethics hearing or judge/jury
  • known BCs can be used as evidence against clrs if not properly handled - the panel/judge may view you as incompetent or incapable of understanding the clrs professional guidelines that dictate no harm to clts
Term
SPECIFIC BOUNDARRY ISSUES - BARTERING
Definition
  • bartering for goods & services is not prohibited by ethical standards of the clg profession
  • clrs who enter bartering agreemts want to aid clts whose funding is limited & cannot afford the clg services by alternative means of pymt
  • ex. clt offers to redecorate clr's office -service for service
  • clt may feel trapped & resentful if they do not keep up with their services or clr may feel like the work is not being done properly - this will impact negatively on the clg relationship

A.10.d. Bartering

  • Counselors may barter only if the relationship is not exploitive or harmful and does not place the counselor in an unfair advantage, if the client requests it, and if such arrangements are an accepted practice among professionals in the community.
  • Counselors consider the cultural implications of bartering and discuss relevant concerns with clients and document such agreements in a clear written contract.

  • Dviersity considerations - it would be acceptable if clt initiate the request & if the clr believes both can work out a fair & equitable agreemt

 

Term
SOCIAL RELATIONSHIPS WITH CLIENTS
Definition
  • clrs have an ethical & professional responsibility to keep their professional & social lives separate - they should not get their personal/social needs for friendship met thru interactions with clts
  • Business relationships with clients - clrs should avoid entering into these relationships with current or former clts-making monetary profit from a secondary relationship with clt serves clr's self-interests
Term
ACCEPTING GIFTS FROM CLIENTS
Definition
  • the best way to minimize the conflict  is have a general policy that clr do not accept gifts from clts & include a statemt in your inform consent

A.10.e. Receiving Gifts

  • Counselors understand the challenges of accepting gifts from clients and recognize that in some cultures, small gifts are a token of respect and showing gratitude.
  • When determining whether or not to accept a gift from clients, counselors take into account the therapeutic relationship, the monetary value of the gift, a client’s motivation for giving the gift, and the counselor’s motivation for wanting or declining the gift.
  • keep in mid that you have a fiduciary relationship with clt & clr must not benefit from it -think about the implicit messages being sent to clt which will blur the professional boundaries
  • consider  your obligation to avoid using clts to meet your social needs - when considering a gift, your reasoning must be based on clt's welfare

 

Term
SELF-DISCLOSURE
Definition
  • it can be powerful when used as a technique to strengthen CR
  • clrs self-disclosures should be done for clt's benefit - ethical appropriate - they become unethical when they are meeting the clr's needs for intimacy & understanding
  • if used excessively can lead to role reversal where clt becomes the clr vice versa
  • when choosing to self-disclose, your primary reason must be that you believe disclosure will benefit clt & take cultural factors into consideration
  • Diversity considerations -for cultures who self-disclosure is an issue, clrs should try to establish a close personal relationship
Term
PHYSICAL CONTACT WITH CLIENTS
Definition
  • clrs should not make physical contact with clients unless it is requested by the clt
  • clrs who engage in these behaviors may have their gestures misinterpreted as advances  or violations of the clt's personal space
  • clrs to use their professional judgment
Term
SEXUAL DUAL RELATIONSHIPS
Definition
  • most offenders are repaet offenders who are suffering from burnout, impaired, experiencing distress in their lives or psychological disorders
  • rationales: reversal of roles,failing to address the emotional closeness-got out of hand, clr used drugs, intimidation, threats, & expolited clts' weaknesses

Harm to clts

  • 90% of clts are damaged by their clrs- clts experience PTSD like other trauma victims, deep ambivalence feeling trapped betw dependency, fear of separation fr clr & longing to escape from his power & influence
  • clt feels guilty believing they are to blame for the relationship, they think its something they did-they have suppressed anger & rage which turns inward leads to incrase risk of suicide
  • clts feel isolated b/c they cannot reveal what is happening, they are confused about their sexuality, appropriate roles, interpersonal boundaries
  • violation of fiduciary relationship leave clts with impaired ability to trust which may prevent them from seeking help in future
  • ACA Codes A5a, A5b
Term
LEGAL CONSEQUENCES FOR OFFENDING CLRS
Definition
  • civil law suits -impropriety of sexual intimacies victims may file civil suit against clr for breach of contract, malpractice, neglience infliction of emotional distress, battery, fraudulent misrepresentation, breach of warranty, infliction of emotional distress

Criminalization of sex with clts

  • many states have pass leglislatures, statues stating tha sexual intimacy with clts are criminal act. clrs can lose their business or license if prove they are harmful to clts

Post counseling sexual relationships

  • APA 2 yrs, ACA 5yrs after clg termination or last session clr may date former clts but have an ethical responsibility to ensure no harm is done, document whether interactions may be viewed as exploitive to clts welfare

Sexual attraction to clts

  • clrs have an ethical responsibility to acknowledge, deal with, seek clg, supervision, consult, & self-monitor 1's behavior
  • clrs clg clts who were victimized by another clr should exercise caution - do not report incident if clt isn't willing to confront the issue, clr has to respect the clts privacy-governing bodies will not pursue if they have no victim or witness
  • clrs must address the needs of the clts & if they decide to proceed with legal steps, aid clt in this difficult situation
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