Respecting Boundaries — The Don’ts of Dual
This national sample of rural psychologists reported less job burnout . Dual relationships can erode and distort the professional nature of the therapeutic . mental health professionals criticize the concept of firm professional boundaries, . Psychology, Sixth Edition Cognitive psychology is the study of the mental processes people use to modify, make Artificial and natural concepts are examples. Propositions are relationships between concepts or between a concept and a. Dual relationships between therapist and client come in many forms and regard to ethical considerations are those of a sexual nature between client and therapist. For example, if the therapist and client are colleagues in the mental Ethics question: If a School Psychologist and a School Principal in.
We again acknowledge the impossibility of setting firm boundaries appropriate for every consumer under every circumstance.
We are concerned, however, that inappropriate crossings are often rationalized as benevolent or therapeutic. As Brown states, 'In the many cases in which I have testified as an expert witness regarding abuses in psychotherapy and the standards of care, it is a very common experience for me to hear the accused therapist pleading the cause of greater humanity, and even love, as the rationale for having had sex with, breast fed, slow-danced with, gone into business with, move in with, and so on with the complaining client'p.
You may have heard in workshops or read in books or journals that hugging a client, giving a gift to a client, or meeting a client outside of the office constitutes a multiple relationship and is prohibited by our ethics code or by the standard of care sustained by professional licensing boards. You may also have heard or read that telling a client something personal about yourself or unexpectedly encountering a client at a social event are examples of unprofessional multiple relationships.
The inaccuracies, or errors, in our thinking about nonsexual multiple relationships, mire us in confusion and controversy. The errors cripple our movement towards a comprehensive and practical model of ethical decision-making regarding multiple relationships with clients. This study also showed that male therapists are more likely to engage in nonsexual dual relationships with clients of the opposite sex than their female counterparts.
A Practical Guide, 4th EditionWiley, Clarity in thinking through boundary issues for each client is essential. Reflexively applying a rigid set of rules A central theme of this book is that we cannot shift responsibility to a set of rules Every client is unique in some ways, as is every therapist. Each situation is unique in some ways, and situations continue to change.
Nothing can spare us the personal responsibility of making the best effort we can to assess the potential effects of boundary crossings Decisions about boundaries must be made with the greatest possible clarity about the potential benefits and harm, the client's needs and well-being, informed consent and informed refusal, and the therapist's knowledge and competence.
What about multiple social roles? Is it helpful, hurtful, or completely irrelevant for a therapist to provide therapy to a close friend, spouse, or step-child? Are there any potential benefits or risks to social outings with a client meeting for dinner, going to a movie, playing golf, or heading off for a weekend of sightseeingso long as there is no sexual or romantic involvement? What about lending a client money to help pay the rent or buy food and medications? Under what circumstances should a therapist accept bartered services or products as payment for therapy sessions?
The 15 years or so from the early s to the mids saw these and other questions about multiple relationships and boundaries discussed—and often argued—from virtually every point of view, every discipline, and every theoretical orientation.
On Seeing Acquaintances as Patients. Similarly, in the edition of their widely used textbook Ethics in Psychology: Professional Standards and Cases, Patricia Keith-Spiegel and Gerald Koocher discussed ways in which boundary crossings may be unavoidable in good clinical practice and presented ways to think through the ethical implications of specific dual relationships or other boundary issues.
Patrusksa Clarkson, who wrote 'In Recognition of Dual Relationships,' discussed the 'mythical, single relationship' and wrote that 'it is impossible for most psychotherapists to avoid all situations in which conflicting interests or multiple roles might exist'p.
Vincent Rinella and Alvin Gerstein argued that 'the underlying moral and ethical rationale for prohibiting dual relationships DRs is no longer tenable'p.
Dual Relationships, Multiple Relationships, & Boundary Decisions
Jeanne Adleman and Susan Barrett took a fresh and creative look, from a feminist perspective, at how to make careful decisions about dual relationships and boundary issues. Laura Brown ; see also b examined the implications of boundary decisions from another perspective in 'Beyond Thou Shalt Not: Purpose Though practitioners often miss the mark or fail to understand the possibility for dual relationships and how to cope with a specific relational dilemma, the issue still remain a major discuss in clinical psychology till date.
This paper will examine and shed light on the complexities of dual relationship and boundary crossing in clinical psychology and explain the pertinent moral and clinical worries that clinical psychologist's face in their practice. The paper will also look at how the concepts influence the decision making process and make a distinction between the following: To realize this, the paper focuses on two underlying themes: Lastly, the paper uses the decision making model to address the concept, challenges and variances associated with dual relationship in clinical psychology and come up with strategies that help psychologists to make flawless ethical standards and offer moral guidance regarding dual relationships.
Methodology This paper analysed and reviewed empirical literature in order to investigates and check new empirical studies that highlights the complexities of dual relationship and boundary crossing in clinical psychology. The study collated and reviewed relevant articles, books, journals, and meta-analysis on dual relationship, boundary crossing and ethical decision making.
This procedure initially reported about articles, journals, technical reports, paper presentation and book chapters covering more than 23 year period.
Based on the abstracts retrieved from this initial plus articles and publications, the search was lessened to a relatively few hundred of studies that are pertinent and relevant to the theme of this paper. The contents of the remaining several hundred of articles cum journals were further scrutinised and only those that reported empirical findings were kept aside and used in this review, while others were left out of further consideration.
This process shows that only a few studies documented empirical findings on boundary crossing and dual relationship in clinical psychology practice. To verify references, manual searches of relevant journals and articles related to the paper are performed.Freud's Psychoanalytic Theory on Instincts: Motivation, Personality and Development
Literature Review Dual Relationship and Boundaries in Clinical Practice As we all know, the major concern of psychology profession is to promote the well-being and welfare of others, however, this statement as well as it sound, has come to the utmost scrutiny in recent time. Clinical psychologist faces daily, how to handle the issue of dual relationships and boundary crossing without compromising their professional conduct and practice.
Earlier research, particularly during the 80s and 90s established how hypothetical orientation, community size, psychoanalyst sexual characteristics, client sexual category, occupation, and other issues, impacts on the level that therapists involved in dual relationship or crossing several boundaries in their profession, particularly, feelings about the nature and suitability of borderline crossings.
Besides, the period between the s and s also witnessed a practical outburst of healthy argument and considerate works on dual relationships, bartering, companionable touch, out of office consultation and other nonsexual boundary matters to mention a few, that faces health professionals.
Also, there were thought-provoking and considerate literature that observed the constructive and undesirable aspects, the dangers and advantages of different boundaries and boundary crossings. A typical example of this is the article by American Psychologist in requesting for drastic changes in the ethics code. Unfortunately, the literature reveals that many people have been victims of ethical issues for years. These problems have been linked to lack of clarity and awareness on when and how to engage with clients.
Also, Sonne complemented this statement by mentioned that, of all the problems facing APA members, the issue of dual relationship was the most common reason for their membership termination. As a result of the ambiguity surrounding the concepts, it attracted serious litigation and other disciplinary cases such as ethics committee hearings, and complaints to professional boards of licensure.
In this spirit, the therapist has an obligation to discuss this factor in detail with the patient prior to entering into the dual relationship and must also keep this topic and related issues at the forefront of treatment to avoid any damage to the therapeutic alliance.
Dual Relationships and Boundary crossing. A Critical Issues in Clinical Psychology Practice
Am I being objective in my evaluation of this matter? This is a very difficult question to answer since it is arguable that no one is really objective. The answer to this question requires consultation with others, and not only those in the mental health field but also in related fields, like law. Personal needs are not things with which we are always in touch and given the inherent high level of risk that is associated with this type of conduct, one must not only answer the above questions by oneself, but should go through them with another individual to assure that the answers are as objective as they could be.
Once a therapist has addressed the above questions, he or she is now forced to move into what could be termed "risk management mode. In that spirit, the mental health professional that has addressed the previous questions and has obtained a positive outcome, must now address the following.
Have I adequately documented the decision making process in the treatment records?
Dual Relationships, Multiple Relationships, & Boundaries
Since the spirit of the law is, "If it is not written down, it did not happen," inadequate documentation can negate the existence and value of the whole decision making process.
That is, if, while addressing all of the above questions, the mental health professional failed to document the process, then the protection afforded by having done so, becomes lost. Good record keeping can become a significant defense to allegations of professional misconduct and negligence on the part of a psychologist who chooses to engage in a dual relationship.
If the record reflects a carefully thought out decision making process that led to the choice to engage in a dual relationship, it can lend great strength to the psychologist's defense in these types of matters. The records in these types of cases should reflect the process by which the choice was made to engage in the dual relationship and should, hopefully, lead the reader to the same conclusions. It should reflect all consultations made about the issue and logically explain to the reader why the mental health professional chose to engage in the secondary relationship.
If the record fails to do this, it may leave the psychologist in a rather self serving position of possibly being the only witness who supports the choice that is in question - a rather self-serving and unenviable position in which to be. A good record, when a choice is called into question, lives almost like a second witness to what actually occurred and if this witness supports the psychologist's choice, then in lends great strength to the argument that the choice was the right one.
Did the client give informed consent regarding the risks to engaging in the dual relationship? While the patient or client is never in charge of choosing what a therapist does, when confronted by risky clinical situations, a professional is well advised to make sure that the client understands the issues at hand.
That is, has the psychologists addressed all of the possible dilemmas and risks with the client and does the client understand them? If the answer to these questions is, yes, then the next question closely follows. Does the documentation reflect that the patients has been informed and consents to the relationship? This documentation could take the form of a signed document reflecting the agreement or could consist of a note in the patient's chart.
While a note is weaker evidence of informed consent, it still becomes strong evidence that something did, in fact, occur. It is important to point out, however, that patients can never give informed consent to something that poses severe risk to them and is a violation of an existing standard of care.
A good example of this would be a consent to engage in a sexual relationship with a patient. Even if one chose to try to use informed consent as a defense is these types of cases the correctness of the choice, if you will, would be negated by the previous questions raised in this discussion.