Chapter 7 – Managing Boundaries and Multiple Relationships

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Multiple Relationships
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A practitioner is in a professional role with a person in addition to another role with that same individual, or with another person who is close to that individual.
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Other Names for Multiple Relationships
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Dual Relationships Nonprofessional Relationships
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The Main Concern of Multiple Relationships
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Risk of exploitation of the client, harm to the client, and impairment of professional judgement. If any of these take place, the client can sew the professional.
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Reasons to enter Multiple Relationships
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Mentoring. When it is clear that it is in the best interest of the client. If there is sound clinical justification for doing so, then it is good practice to document precautions practitioners take to protect clients when such relationships are unavoidable.
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Younggren and Gottlieb’s view of MRs
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Evaluate the necessity of multipe roles and relationships, evaluate the potential benefit and potential risk to the client of entering in to a multiple relationship, reflect on the clinician’s ability to be objective in the situation, and seek consultation with colleagues.
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Boundary Crossing
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A departure from commonly accepted practices that could potentially benefit clients. May be clinically relevant and appropriate in some cases.
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Boundary Violation
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A serious breach that results in harm to clients and is therefore unethical. If a therapists actions result in harm to a client.
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A common type of boundary crossing:
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Therapist self-disclosure.
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Author Recommendations regarding Appropriate Boundaries
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Therapists who make it a practice to venture outside of the office or engage in nontraditional activities with clients make this clear at the outset of therapy during the informed consent process. Might also consult wiht their insurance carrier about such practices as these activities may have implications for one’s liability.
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Solidarity
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Rooted in the ties within a society that bind people together, as a culturally congruent way of understanding defining and managing boundaries. “Solidarity between byself and my clients both allowed and required me to be myself, to give primacy to the real relationship, to establish close boundaries and to act in clients’ best interests.
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Role Blending
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Combining roles and responsibilities, is quite common in some professions. Example: Counselor educators serve as instructors, but the sometimes act as therapeutic agents for their student’s personal development.
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Slippery Slope Phenomenon
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Once a practitioner crosses a boundary, the tendency to engage in a series of increasingly serious boundary violations can lead to a progressive deterioration of ethical behavior.
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The Changing Perspectives on Nonsexual Multiple Relationships
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The absolute ban on multiple relationships has been replaced with cautions against taking advantage of the power differential in the therapeutic relationship and exploiting the client, while acknowledging that some boundary crossings can be beneficial.
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Lazarus’ Perspective of Boundaries
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Professionals who hide behind rigid boundaries often fail to be of genuine help to their clients. Some well-intentioned ethical standards can be transformed into artificial boundaries that result in destructive prohibitions and undermine clinical effectiveness.
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Gabbard’s view of Lazarus’ Perspective
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He fears that Lazarus is “teetering on the precipice.” Failing to establish clear boundaries can be very dangerous to both the client and the therapist. Boundaries provide safety for clients.
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Lazarus’s Rejoinder to Criticism
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The major difference between his views and those of the respondents is that they dwell mainly on the potential costs and risks, whereas h focuses mainly on the potential advantages that may occur when certain boundaries are transcended.
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Three helpful criteria in making decisions about MRs:
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1. risk of exploitation. 2. loss of therapist objectivity. 3. harm to the professional relationship.
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How to Minimize Risk and Maintain Professionalism
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Obtain informed consent. Document thoroughly. Set clear boundaries and expectations, both for yourself and with your clients. Pay attention to matters of confidentiality. Get involved in ongoing consultation.
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Bartering
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Exchanging goods or services in lieu of a fee.
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APA view of Bartering
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Psychologists may barter only if 1. it is not clinically contraindicated (harmful), and 2. the resulting arrangement is not exploitative.
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Authors’ View of Bartering
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They agree with the general tone of these standards, although we would add that bartering should be evaluated within a cultural context.
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Benefits of Bartering
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A way to provide counseling services in some regions o individuals who could not otherwise afford counseling.
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Woody (the lawer)’s View of Bartering
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Could be argued that it is below the minimum standard of practice. You will have to demonstrate proof that 1. the bartering arrangement is in the best interests of your client 2. is reasonable, equitable, and undertaken without undue influence; and c. does not get in the way of providing quality psychological services to your client.
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Giving or Receiving Gifts
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Accepting certain kinds of gifts (highly personal items) would be inappropriate and require exploring the client’s motivation. Practitioners may want to inquire what meaning even small gifts have to the client.
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Reasons for Discouraging Friendships with Clients Outside of Counseling:
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1. therapists may not be as challenging as they need to be with clients they know socially because of a need to be liked and accepted by the client; 2. counselors’ own needs may be enmeshed with those of their clients to the point that objectivity is lost; and 3. counselors are at greater risk of exploiting clients because of the power differential in the therapeutic relationship.
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Sexual Attractions in the Counseling Relationship: 82%…
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Reported that they had never seriously considered actual sexual involvement with a client.
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Sexual Attraction in the Counseling Relationship: 93.5%…
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Reported never having had sexual relations with their clients.
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Sexual Attraction in the Counseling Relationship: 10.3% vs. 89.7%
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10.3% of counselors thought it was ethical to reveal a sexual attraction to a client; 89.7% thought it was unethical.
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Sexual Contact with Clients
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Clearly unethical, and all major professional ethics codes have specific prohibitions against them. Most states have declared such relationships to be a violation of the law. One of the most serious of all ethical violations for a therapist, but is also one of the most common allegations in malpractice suits.
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Sexual Relations with Former Clients
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Most professional organizations prohibit their members from engaging in sexual relationships with Former clients because of the potential for harm. Some organizations specify a time period, and others do not.
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Nonerotic Touching with Clients
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Can be appropriate and can have significant therapeutic value. Can be reassuring and a part of the healing process. Is counterproductive when it distracts clients from experiencing what they are feeling, or when clients do not want to be touched.
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Nonsexual Touch 83.9%…
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Of counselors endorsed the idea that it was ethical to console clients using non-erotic touch.
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Nonsexual Touch 66.7%…
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Of counselors believed it was ethical to hug clients.

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