Issues and Ethics in the Helping Professions Tenth Edition Boundaries and the Mental Health Professional: Being Ethical and Dual/Multiple Relationships Carol Campbell, Ph.D. Copyright © 2019 Cengage Learning. All Rights Reserved.

Learning Objectives (1 of 2) 7-1 State the ethical guidelines regarding dual or multiple relationships. 7-2 Appreciate various perspectives on multiple relationships. 7-3 Identify factors to consider before entering into a multiple relationship. 7-4 Differentiate between boundary crossings and boundary violations. 7-5 Critically evaluate the controversies on boundary issues. 7-6 Understand ethical challenges in managing multiple relationships in small communities.

Learning Objectives (2 of 2) 7-7 Explore the pros and cons of bartering for professional services. 7-8 Formulate guidelines on receiving gifts from clients. 7-9 Describe ethical issues regarding forming social relationships with current or former clients. 7-10 Articulate guidelines for dealing with sexual attractions in the therapy relationship. 7-11 Recognize the ethical and legal aspects of sexual misconduct. 7-12 Clarify guidelines for the use of touch in the therapy relationship.

Boundary Crossings and Multiple Relationships Boundary crossings or multiple relationships increase the possibility for therapists to misuse their power to influence and exploit clients for their own benefit and to the clients’ detriment. Some suggest it is good practice to abstain from crossing boundaries or engaging in multiple relationships, but this is not always possible.

The Ethics of Multiple Relationships Codes caution professionals against any involvement with clients that might: Impair their judgment and objectivity Affect their ability to render effective services Result in harm or exploitation of clients

Differing Perspectives on Multiple Relationships The viewpoints on multiple relationships vary: Some focus on the problems inherent in multiple relationships. Others view them as common, inevitable, unavoidable, normal, and a healthy part of communal life in many settings.

Before Entering Into a Multiple Relationship Factors to consider: Therapist’s motivation Consistent with client’s treatment plan Client’s history, culture, values, and diagnosis Rationale documented in the client’s record Discussed in advance to prevent misunderstandings Client’s trust is safeguarded Consultation with colleagues

Boundary Crossings Versus Boundary Violations A departure from commonly accepted practices that could potentially benefit clients Example: Attending a student’s school play or sports event to build a positive relationship with him or her Boundary violation: A serious breach that results in harm to clients and is therefore unethical A gradual erosion of boundaries that leads to sexual exploitation of the client.

Minimizing Risks in Multiple Relationships Identify measures aimed at minimizing the risks: Set healthy boundaries from the outset. Secure informed consent of clients. Discuss both potential risks and benefits. Consult with other professionals to resolve any dilemmas. Seek supervision when needed. Document in clinical case notes. Examine your own motivations. Refer when necessary.

Perspectives on Boundary Issues Arnold Lazarus has taken the position that a general proscription against dual and multiple relationships has led to: unfair and inconsistent decisions by state licensing boards, brought sanctions against practitioners who have done no harm, and sometimes impeded a therapist’s ability to perform optimum work with a client.

Managing Multiple Relationships: Small Community Practitioners who work in small communities often have to blend several professional roles and functions. They have to become an integral part of the community to be accepted as a credible mental health resource. If these practitioners isolate themselves from the surrounding community, they are likely to alienate potential clients and thus reduce their effectiveness in the settings where they work.

Prior to Establishing a Bartering Relationship Evaluate whether it puts you at risk of impaired professional judgment. Determine the value of goods or services in a collaborative fashion. Determine appropriate length of time for arrangement. Document arrangement and consult with experienced colleagues or supervisors.

Bartering Guidelines to clarify barter arrangements: Minimize unique financial arrangements. If bartering is used, it is better to exchange goods rather than services. Both therapist and client should have a written agreement for the compensation by bartering. If a misunderstanding develops, the matter should be dealt with by a mediator, not by you and your client.

Giving or Receiving Gifts When deciding whether or not to accept a gift from a client, ask yourself: What is the monetary value of the gift? What are the clinical implications of accepting or rejecting the gift? When in the therapy process is the offering of a gift occurring? What are my motivations for accepting or rejecting a gift? What are the cultural implications of offering a gift?

Social Relationships With Clients Disadvantages: Therapists may not challenge clients they know socially because of a need to be liked and accepted by the client. Counselors’ own needs may be enmeshed with those of their clients to the point that objectivity is lost. Counselors are at greater risk of exploiting clients because of the power differential in the therapeutic relationship. Former clients may need you more as a therapist at some future time than as a friend.

Sexual Attractions in Therapy Attraction to clients is a prevalent experience among both male and female therapists. Simply experiencing sexual attraction to a client, without acting on it, makes the majority of therapists feel guilty, anxious, and confused. There is a distinction between finding a client sexually attractive and being preoccupied with this attraction. Neglecting to attend to family-of-origin issues can lead to blind spots such as being attracted to clients.

Dealing with Sexual Attractions (1 of 2) To minimize the likelihood of sexual transgressions: Learn to recognize sexual attractions and how to deal with these feelings constructively and therapeutically. Seek professional support during times of loss or crisis. Examine and monitor feelings and behaviors toward clients continually. Know the difference between having sexual attraction to clients and acting on this attraction. Learn about the possible adverse consequences for clients and therapists who engage in sexual activity. Establish and maintain clear boundaries when a client makes sexual advances toward you.

Dealing with Sexual Attractions (2 of 2) Terminate the therapeutic relationship when sexual feelings obscure objectivity. Recognize that direct explicit disclosures of sexual feelings can run the risk of harming clients and may therefore be unethical. Rather than making any explicit communication of sexual feelings for clients, acknowledge caring and warmth within the therapeutic relationship. Practice a risk management approach (e.g., be aware of timing and the location of scheduled appointments, non erotic touch, and general self-disclosure). Be open to using supervision, consultation, and personal therapy throughout your career.

Harmful Effects of Sexual Contact With Clients Clients who are the victims of sexual misconduct suffer dire consequences: Distrust of the opposite sex Distrust of therapists and the therapeutic process Guilt, depression, anger, and/or PTSD Feeling of rejection and low self-esteem Suicidal ideation

Legal Sanctions Against Sexual Violators Negative consequences for therapists include: Being the target of a lawsuit Being convicted of a felony Having license revoked or suspended by state Being expelled from professional organizations Losing their insurance coverage Losing their jobs

Nonerotic Touching With Clients One of the more controversial boundary crossings Can be appropriate and have significant therapeutic value A genuine expression of caring and compassion Reassuring and a part of the healing process Counterproductive when it distracts clients from experiencing what they are feeling

Carol Campbell, Ph.D. Email: ccampbell@mcneese.edu