1. 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.

2. 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.

3. 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 Articulate guidelines for dealing with sexual attractions in the therapy relationship Recognize the ethical and legal aspects of sexual misconduct Clarify guidelines for the use of touch in the therapy relationship.

4. 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.

5. 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

6. 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.

7. 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

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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?

15. 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.

16. 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.

17. 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.

18. 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.

19. 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

20. 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

21. 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

22. Carol Campbell, Ph.D.