● Imagine the best and worst possible outcomes from crossing the boundary and not crossing the boundary. Will doing so involve risk of negative consequences, or risk of serious harm in the short or long term? ● Consider any available research regarding the boundary crossing. ● Consider guidance offered by professional guidelines, ethics codes, legislation, case law, and other resources. ● Have at least one colleague you can trust to give honest feedback about boundary crossing issues. ● Pay attention to any uneasy feelings, doubts, or confusion and try to identify what is causing them and what implications they may have for your decision. ● When starting therapy as part of the informed consent discussion, describe to the client exactly what type of therapy you do. If warranted, refer them to a colleague who may be better suited for the client. ● Refer to a colleague any client that you feel incompetent to treat or that you do not feel you could work effectively with. ● Pay attention to informed consent for any planned or obvious boundary crossing. ● Keep notes on any planned boundary crossing describing why, in your clinical judgment, you feel it is necessary or helpful to the client. psychologist objectivity in treatment, or issues with power differentials may come into play. Becoming social friends with a former client deprives them of the psychologist’s professional services if they need therapy in the future and may create unrealistic expectations on the part of the client if they see a new psychologist. Psychologists are encouraged to objectively assess and review their privacy settings on all social media accounts and their motivations for those settings. Bartering is another area that poses a potential multiple relationship. Rule 6.05 defines bartering as the acceptance of goods, services, or other nonmonetary renumeration from clients in return for psychological services. It is not specifically prohibited, provided that it is not clinically contraindicated and does not result in an exploitive arrangement. However, entering into a bartering agreement can potentially lead to problems in the therapeutic relationship. What happens if the client does not fulfill their part of the barter? What if services by either party do not meet the other party’s expectations for quality or timeliness? When the affordability of the psychologist’s services is an issue, referral to a lower fee option or use of a sliding scale fee schedule may be better than bartering. Formal consent must be obtained from a legally authorized person. ● The informed consent process and agreement should be documented in the client’s chart. These factors take into consideration the client’s understanding of the proposed treatment, their legal capacity to make an informed decision to initiate treatment, and the voluntary nature of their decision free from coercion or misunderstanding. A written standardized informed consent form should document the type of treatment, risks and benefits, and limits of confidentiality. It should be signed by the client or person legally able to make informed consent. Given the insurance climate, signatures along with documentation about the length of treatment, number of sessions, insurance copays, and expected disclosures to the
The boundary violation usually takes the psychologist out of the professional role, it benefits the psychologist more than the client, there is significant risk in harming the client, and it transgresses an ethical standard. Sexual relationships are an example of a boundary violation, are extremely harmful to clients, and are specifically prohibited (Rule 10.05), as are such relationships with relatives and significant others of current clients (Rule 10.06). Exerting undue influence and taking advantage of a client are other examples of boundary violations. Boundary crossings, on the other hand, are a more common occurrence in daily practice. Consider these situations: ● Allowing a former client to friend you on social media. ● Having a client who recently lost their job ask you to temporarily waive your fee. All deviate from classical practice but are not necessarily harmful. However, self-reflection by the psychologist is necessary to ensure that the client’s needs and well-being are not at risk. ● Running into a client at the store. ● Accepting a minor gift from a client. ● Extending the length of a session. Pope and Keith-Spiegel (2008) discuss nine guidelines to consider when making decisions involving boundary crossings and whether they will be helpful or harmful to the client: Dual/multiple relationships A psychologist refrains from entering into a multiple relationship if it could impair the psychologist’s effectiveness or if could cause harm to the client (Rule 3.05). Entering into a business relationship with a former client, providing therapy to more than one family member, seeing a friend in therapy, and having a social relationship with a former client all constitute a multiple relationship. It may not be possible to avoid some multiple relationships; therefore, it is important to note that the standard also states that if the multiple relationship would not reasonably be expected to cause harm or exploitation, then it is not unethical. Questions to consider when reflecting on whether a nonsexual multiple relationship is ethical include: ● Is the relationship likely to cause harm? ● Would the relationship be beneficial to the client? ● Is the multiple relationship necessary, or can it be avoided? ● What are the motivations of the psychologist and client for the relationship? In the age of social media, it has become increasingly difficult to avoid inadvertently entering into a social relationship with a client. Accepting a client’s friend request and a client following you on your social media account are potentially problematic. Loss of psychologist privacy, loss of Informed consent Psychologists obtain informed consent from clients (Rule 3.10). Treatment without informed consent violates ethical responsibilities and does not meet the minimum standard of care for psychologists. Informed consent involves several factors: ● The psychologist must provide information about proposed services using language that is understandable to the client. ● The client must be able to understand the information in order to make an informed decision about engaging in services. ● If the client is not legally capable of giving informed consent, the psychologist should still provide an explanation of services and attempt to obtain assent.
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