Case I: Boundaries Violation Dual Relationships

Could the client have any other psychiatric disorder? If so, list and include supporting DSM-IV-TR criteria.

During the film Antwone Fisher (Black, Haines, & Washington, 2002) the therapist who worked with Antwone seemed to have Antwone’s best interest at heart, but still managed to violate some ethical codes. One of the first violations that I noticed was when he tried to terminate therapy with Antwone after only three sessions. Whereas he initially informed Antwone that he was only required to see him for three sessions, as the sessions progressed it seemed obvious to me that Antwone may need more, and even asked to come back for a fourth session. According to the 2014 American Counseling Association (ACA) Code of Ethics, A. 11.c. Appropriate Termination, “Counselors terminate a counseling relationship when it becomes reasonably apparent that the client no longer needs assistance, is not likely to benefit, or is being harmed by continued counseling.” I think that the therapist trying to terminate therapy with Antwone after three sessions was an obvious violation of this ethics code as it was not in Antwone’s best interest, especially given how much distress it caused him.

The nature of therapist-client relationship and understanding the therapist’s role is vital in making sure that the client’s rights are not jeopardized. The client must be willing to trust the therapist. The therapist can earn the trust of the client will confidentiality guidelines that are established by requiring informed consent. The therapist-client relationship is based on counseling approach as well as relationship with the client. The therapist’s role is to understand the client’s needs, help them get their needs met mentally, and to develop the proper plan that fits the client’s needs. The therapist must fully

This paper will discuss the concept of non-sexual dual relationships between Ms. C and Ms. R., and the ethical consequences of relationships. This paper will also an ethical standard to use a guide when facing a dilemma like Ms. C. In addition to discussing ethical consequences, this paper will also explore how ethical decisions must be made to avoid potentially harmful or exploitive relationships in therapy as well understanding how the Virginia Certificate Board, located in Virginia, may deal with reporting dual relationships, and how different interactions between Ms. C and Ms. R can be understood from an ethical standpoint, as well as preventive measures to avoid dual relationships.

The APA Ethical Principals of Psychologists and Code of Conduct (Section 4.09c) states, "Prior to termination for whatever reason, except where precluded by the patient's or client's conduct, the psychologist discusses the patient's or client's views and needs, provides appropriate predetermination counseling, suggest alternative service providers as appropriate and takes other reasonable steps to facilitate transfer of responsibility to another provider if the patient or client need ones immediately" (American Psychological Association, 1992, pp. 1597-1611).

In clinical practice it is wise for mental health professionals to monitor boundary crossing or multiple relationships. These roles have the potential for therapist to use power inappropriately through influence or exploitation of clients. Therefore it is essential to continually monitor the impact of the behavior on clients (Corey et al., 2011). From ethical perspective dual relationships in its self is not a malpractice. The legal aspect depends on the nature of the relationships.

In this scenario, as a psychologist I face several ethical issues. According to the American Psychological Association, Ethical Principles of Psychologist and Code of Conduct there are at least six standards I have to

123). The role of a mental health counselor is critical when communicating with any prescribing professional since it "maximizes client outcomes where integrative therapies are involved" (Dickinson & Kaut, 2009 p. 218). Because the psychotherapist is in contact with the patient, he or she has the opportunity to join forces with others in the medical profession and be their eyes and ears to the appropriate professionals. As the treatment continues the mental health counselor re-assesses both the effects of treatment. Overall, the focus is on the client’s best interest (Anderson & King, 2004).

Trading goods and services is can work out for the best when it is not clinically contraindicated, and the relationship is not exploitative. I am on the line with exploration. If I offered my client services for free with no work or payment in return, I can certainly help her with her sessions but it would be at a lost for me. I am offering her an exchange which will benefit her but it also benefits me.

In today’s psychology profession, a therapist and even the client can cross many boundaries if immediate boundaries are not put into place during the initial visit. Some boundaries that are crossed are not a problem at first and then the problem progresses. Leonard L. Glass called these, “the gray areas of boundary crossing and violation” (429). However, there is further description, “Boundary issues mostly refer to the therapist's self-disclosure, touch, an exchange of gifts, bartering and fees, length and location of sessions and contact outside the office” (Guthiel & Gabbard). This statement by Thomas G. Gutheil, M.D. & Glen O. Gabbard, M.D explains the meaning of boundary

For human service professionals, conflicts of interest have become some of the most problematic and challenging issues that they face. A conflict of interest occurs when a human service professional’s relationship or services with a client is compromised because of actions or decisions related to another client, a colleague, the client themselves, or a third party. When it comes to conflicts of interest it is important to remember that boundaries in therapy have been put in place for a very important reason. Human service professionals “should not take unfair advantage of any professional relationship or exploit others to further their personal, religious, political, or business interests” (National Association of Social Worker, 1996). Not all boundaries in therapy are problematic or unethical, however many are. Boundary crossing, boundary violations, and dual and multiple relationships are some of the most common conflicts of interest that occur in the human service profession.

Research has shown that a strong therapeutic alliance is necessary for establishing a beneficial contact between the therapist and the client. If the therapist does not encourage the creation of a reliable therapeutic alliance from the beginning of the treatment, it will be hard to develop a constructive relationship with the client later. Establishing the therapeutic alliance will increase the chances of achieving the goal of the treatment because the clients will be willing to cooperate if they trust and respect the therapist. Clients are not likely to cooperate with therapists who impose their authority aggressively. Instead of imposing their authority on the patient, therapists should develop work with their patients by

It is well accepted in the mental health field that the counselor’s well-being impacts treatment effectiveness (Warren, Morgan, Morris, & Morris, 2010). This has led to ethical mandates in efforts to increase the quality of services received by recipients of mental health service (American Counseling Association [ACA], 2005, section C). However, even with these ethical responsibilities, as Charles Figley (2002) indicates, psychotherapists tend to overlook their own mental health as they put the welfare of their clients first. In actuality, this leads to decreased “capacity and interest in bearing the suffering of others” (Figley, 2002, p. 1424). According to Figley, this occurs because as psychotherapists hear the stories of others who suffer,

When developing a treatment plan for any complex case, it is critical to consider any factors that contribute to the client’s situation. One must generate a plan of action that will support the client appropriately and yet not be overwhelming. It often takes a long time for a client to come to terms that they need help. For many, seeking mental health services can be both a daunting and intimidating laden with feelings of failure and disappointment.

Dual relationships and the ethical behavior that revolves around boundaries with clients present a multitude of very complicated situations to counselors where a clearly defined course of action is not always evident. Aside from no accord amongst mental health professionals and boundary issues being unavoidable at times, recognition and prediction of potential benefits or pitfalls correlated with dual relationships can prove to be troublesome as well (Remley & Herlihy, 2010). For most cases, it is best if an outline is used to discern when it is appropriate for a counselor to breach the client-counselor boundary.