mountain to climb. Also, psychologist and clients are regularly hindered by .. is a vital feature of critical thinking and ethical decisions. 2 The Code of Ethics uses the term “psychologist” to refer to critical reflection of knowledge and self-reflection about one's own skills and attitudes. I. 4 Relationship with clients, other parties, colleagues and other. Ethics is a critical issue in every helping profession, in which the a human therapist as well as the critical thinking on how to create strategies for self-care and—in relationships with clients are also very important aspects of ethical behavior.
Kudos to Pope and Vasquez. American Psychological Association "It is essentially a superb text about the practice of psychotherapy, with all its unexpected twists, turns, and difficulties for therapists and patients. From its excellent short courses on logical and ethical fallacies, to its astonishing variety of intensely provocative case examples with self-assessment questions, to its steamy discussions of therapists' sexual feelings, the book illuminates, in a non-threatening, conversational tone, the previously-avoided dimensions of the therapeutic endeavor.
It belongs on the shelf of any therapist willing to learn or think critically about psychotherapy. American Psychological Association "This comprehensive practical guidebook is a must for all new and seasoned clinicians. From attorneys to ethics, from billing to possible errors in logic--it is all here.
Articles, Research, & Resources in Psychology
Kudos to Pope and Vasquez! American Psychological Association "A must for every trial lawyer's library. It is that rarest of books with which the reader shares an intimate dialogue of personal discovery.
Powerful, truthful, and adventurous, it will serve as an essential text to which seasoned therapists will return again and again and should be required reading in all training programs.
American Psychological Association "A landmark contribution. The research, forms, and lists of cross-examination questions will be invaluable to subsequent therapists who appear in court.
This unique resource is essential reading for expert witnesses and trial attorneys. A storehouse of information. Plaintiff and defense lawyers and expert witnesses would be well advised to be aware of its contents. To offer the client extra time seems a kind gesture but runs counter to the therapeutic agreement. In the future, this actual client felt entitled to extra time and resented not getting it.
In the meantime, clients-in-waiting have an agreed upon appointment obligation altered. One can feel sympathy for the distraught mother, but the matter does not qualify as an emergency. In fact, the mother might more appropriately focus on other actions e. Yet at other times, offering extra time would be prudent, such as in a true emergency situation.
The client who was asked for a favor turned into a bit of a fiasco. The client asked if they could stop on the way home and have dinner together. The therapist refused politely, noting he had to get home to his family.
But now the client, who later became a stalker, knew where he lived. This was a fairly new client with some issues that should have signaled caution on the part of the therapist. His myopic focus on his own convenience ended up costing him dearly.
Regarding the client struggling with her winter coat, what seems like an obvious helpful gesture requires brief reflection. This seemingly helpful act involves physical contact, and not all clients will feel comfortable with that.
Some may even feel it as intrusiveness. Asking before acting is essential. The client who brought coffee and sweets to the 10 a. She began to focus less on her own issues and more on that therapist as someone with whom she could have a relationship with outside of the office. The therapist finally picked up on what was going on and attempted, unsuccessfully, to pull the relationship back to the business of therapy. The client experienced the request to cease bringing coffee and sweets as both an insult and a rejection.
She never returned to therapy. Although this case did not result in an ethics complaint, the therapist felt guilty over failing to better perceive how meeting his own needs for what seemed like an innocent pleasure caused pain for a client he liked.
The economically strapped landscaper provides a more complicated case, and we will have more to say about bartering later. However, in such cases, taking someone up on what seems like a good match can turn into an ordeal. Ultimately, the client successfully sued the therapist for exploitation. Unfortunately, the therapist became defensive and told the client that the client must have caused the damage.
The therapeutic alliance evaporated, and the client successfully sued the therapist in small claims court. Finally, certifying the need for an emotional support animal, as opposed to a trained service animal e.
Crossing them has many potential effects. The work of mental health professionals is conducive to permeable role boundaries because so much of it occurs in the context of establishing emotionally meaningful relationships, very often regarding intimate matters that the client has not spoken of to anyone else.
Yet, mental health professionals continue to hold differing perceptions of role mingling. These perceptions range from conscious efforts to sustain objectivity by actively avoiding any interaction or discourse outside of therapeutic issues to loose policies whereby the distinction between therapist and best buddy almost evaporates.
However, even those who would stretch roles into other domains would condemn conspicuous exploitation of clients. Some mental health professionals decry the concept of professional boundaries, asserting that they promote psychotherapy as a mechanical technique rather than relating to clients as unique human beings. Instead, acting as a fully human therapist provides the most constructive way to enhance personal connectedness and honesty in therapeutic relationships Hedges, and may actually improve professional judgment Tomm, Those critical of setting firm professional boundaries further assert that role overlaps become inevitable and that attempting to control them by invoking authority e.
The answer, they say, involves educating both clients and therapists about unavoidable breaks and disruptions in boundaries and to ensure that therapists understand that exploitation is always unethical, regardless of boundary issues.
As the scenarios at the onset of this course reveal, however, exploitation is not the only harmful result of boundary crossings. We believe that the therapist retains ultimate responsibility for keeping the process focused.
Ethics in Psychotherapy and Counseling: A Practical Guide, 3rd ed.
We see no reason why maintaining professional boundaries needs to diminish a therapist's warmth, empathy, and compassion.
The correct task is to match therapy style and technique to a given client's needs Bennett et al. Furthermore, we believe that lax professional boundaries can act as a precursor to exploitation, confusion, and loss of professional objectivity.
Conflicts, which are more likely to arise when boundaries blur, compromise the disinterest as opposed to lack of interest prerequisite for sound professional judgment. As Borys contended, clear and consistent boundaries provide a structured arena, and this may constitute a curative factor in itself. In short, the therapy relationship should remain a safe sanctuary Barnett, that allows clients to focus on themselves and their needs while receiving clear, clean feedback and guidance.
Frank discussions about boundaries with clients during the initial informed consent phase is also recommended. Cultural traditions, geography e.
The ethics code of the American Psychological Association APA, offers a clear definition of multiple role relationships. Multiple role relationships occur when a therapist already has a professional role with a person and: Is also in another role with the same person, or Is also in a relationship with someone closely associated with or related to the person with whom the therapist has the professional relationship, or Makes promises to enter into another relationship in the future with the person or a person closely associated with or related to the person.
To qualify for the definition of multiple role relationship then, the initial relationship typically requires an established connectedness between the parties. The primary role relationship is usually with an ongoing therapy, counseling client, student, or supervisee.
Limited or inconsequential contacts that grow out of chance encounters would not normally fall under the definition or cause for any ethical concerns. Multiple role relationships may occur via action, as when a therapist hires a client as a housekeeper. Or they can take the form of a proposal for the future while therapy remains ongoing, as when a therapist and a client plan to go into business together or agree to start a sexual relationship upon termination of therapy, thus altering the dynamics of the ongoing professional relationship.
Zur has categorized multiple role relationships by types. These categories are illustrated in the cases offered here. Nonsexual consecutive role relationships with ex-clients do not fall under any specific prohibitions in the APA code APA, However, based on post-therapy incidents described in this course, we advise caution even after a natural termination of the professional relationship.
Ethics in Psychotherapy and Counseling: A Practical Guide, 3rd ed.
However, not all multiple role relationships with clients are necessarily unethical so long as no exploitation or risk of harm to the client or the professional relationship can be reasonably expected. We agree that careful consideration should occur prior to softening the boundaries of any professional role, and we also remain unconvinced that accurate outcome predictions involve a simple exercise in judgment.
If that were so, therapists would have the lowest divorce rate of any professional group! Alas, no evidence of such foresight exists. We also contend that justification for entering into some types of multiple role relationships with persons in active treatment does not exist. Sexual and business relationships, for example, pose inherent risks regardless of who is involved.
Neither can be defended as reasonable dimensions to impose on a therapy relationship. Finally, we will comment on how easy it is to rationalize, to convince ourselves that an action is justifiable in a particular situation.
All therapists are vulnerable to self-delusion when their own needs get in the way, even those who are competent and have been scrupulously ethical in the past e. Risk Assessment Kitchener suggests assessing the appropriateness of boundaries by using three guidelines to predict the amount of damage that role blending might create.
Role conflict occurs, says Kitchener, when expectations in one role involve actions or behavior incompatible with another role. First, as the expectations of professionals and those they serve become more incompatible, the potential for harm increases. Second, as obligations associated with the roles become increasingly divergent, the risks of loss of objectivity and divided loyalties rise.
Third, to the extent that the power and prestige of the psychotherapist exceeds that of the client, the potential for exploitation is heightened.
Thus, if after two years of intense therapy and a tenuous termination whereby the client may need to return at any time, no additional roles should be contemplated. The success or failure of this new role relationship would be more about what the parties do as consenting adults as opposed to the brief professional experience.
Brown adds two additional factors that, if present, heighten the risks of harm. Second, boundary violations usually arise from impulse rather than from carefully reasoned consideration of any therapeutic indications.
Thus, hugging a client is not unethical per se, but an assessment of any potential hazards or misunderstandings should precede such an act. Risky Therapists All therapists face some risk for inappropriate role blending Keith-Spiegel, Those with underdeveloped competencies or poor training may prove more prone to improperly blending roles with clients.
However, even those with excellent training and high levels of competence may relate unacceptably with those with whom they work because their own boundaries fail. Some may feel a need for adoration, power, or social connection. The settings are private and intimate. The authority falls on the side of the therapist. Moreover, if things turn sour, the therapist can simply eliminate the relationship by unilaterally terminating the client and can deny that anything untoward occurred should a complaint be initiated by a client.
Indeed, when a client walks through the door, immediate clues become apparent: Multiple authors have discussed the advantages of self-disclosure. Done thoughtfully and judiciously, revealing pertinent information about oneself can facilitate empathy, build trust, and strengthen the therapeutic alliance e. However, those who engage in considerable and revealing self-disclosure with clients stand at greater risk for forming problematic relationships with them.
Instead, this client began to feel that the therapy environment was polluted rather than safe and clean. She quit therapy feeling even more adrift. It is difficult to know in advance how a given client will respond to a self-disclosure, particularly when the subject is in sensitive territory for the client. It seems reasonable to expect that some clients would want to know as much as possible about the person in whom they are placing so much trust.
A skillful therapist can respond without demeaning the client in the process. At the same time Internet searches make considerable information on anyone readily available. Like any other individual who prefers some modicum of privacy, psychotherapists must understand that information posted on personal and social sites will become known to curious clients and may lead to inquiries or promote some other types of boundary blurring. See Kolmes, ; Reamer, The next case involves an indignant response to a fading career, compounded by an absence of close ties with family or friends.
Grandiose might elicit some sympathy were it not for her ill-conceived approach to dealing with her own issues. A well-known and outspoken therapist, Panacea Grandiose, Ph.
However, Grandiose continued to maintain a successful practice, and her clients became the focus of her life. She hosted frequent social events in her home and invited herself along on clients' vacations.The Therapist to Client Relationship
It seems that something about therapists either choosing to work in isolation, or the isolating conditions themselves, foster the potential clouding of professional standards of care. Or perhaps some therapists have experienced rejection by their colleagues, as with Dr. Grandiose, and turn to inappropriate substitutes for support and validation. Regardless of the reason, an insular practice with no provisions for ongoing professional contact diffuses professional identity, thus putting appropriate decision-making at risk.
Therapeutic Orientation and Specialty Practices Some therapists practicing within certain therapeutic orientations are probably more vulnerable to charges of boundary violations. For example, Williams notes that humanistic therapy and encounter group philosophies depend heavily on tearing down interpersonal boundaries. Such therapists often disclose a great deal about themselves, hug their clients, and insist on the use of first names.
These therapists also become, according to Williams, vulnerable to ethics charges even though their practice is consistent with their training.