Professional Boundaries in Mental Health Care _ _________________________________________________
or a big city, there will be times when counselors and clients will encounter one another outside the office. To ignore a client who is reaching out in a social setting may cause the client harm. However, it also is important to avoid violating the client’s privacy. The best way to minimize the potential awkwardness of such an encounter is to prepare ahead of time. For example, a counselor might incorporate a conversation about such an encounter into the initial evaluation process by telling the client: “If I happen to be at a store or a restaurant and see you, I won’t say hello because I respect your confiden- tiality and want to protect your privacy. However, if you want to smile or say hello to me, I will respond in kind.” Explain to the client that the conversation or acknowledgment must be brief to prevent any violation of the client’s privacy. After an encounter in public, address the event in your next session, discuss any feelings the client had about the encounter, and note the discussion in the client record. Such an encounter would not fall under the category of dual/multiple relation- ships unless, for example, the counselor and client went grocery shopping at the same time every week and interacted each time. In this instance, the counselor is advised to change his or her shopping day and/or time in order to avoid risking loss of client confidentiality. BOUNDARY VIOLATIONS WITHIN MULTIPLE RELATIONSHIPS Mental health professionals are forbidden to exploit any person over whom they have supervisory, evaluative, or other similar authority. This includes clients/patients, students, supervisees, research participants, and employees [3; 4]. Professional ethics codes outline specific instances of behaviors and actions (some that are expressly prohibited) that have exploitative potential, including [3; 4; 5]: • Bartering with clients • Sexual relationships with students or supervisees • Sexual intimacies with current or former clients • Sexual intimacies with relatives/significant others of current therapy clients • Therapy with former sexual partners or partners of a romantic relationship • Romantic interactions or relationships with current cli- ents, their romantic partners, or their family members, including electronic interactions or relationships • Physical contact with clients (e.g., cradling or caressing) There are times when a client has an emotional session and hugs the counselor unexpectedly before leaving the office. This physical contact should be noted in the client’s record along with what precipitated it. It should be revisited with the client at the next session, with this discussion recorded in the client’s record. While you may prefer no physical contact, you can try to respond positively to the desire for closeness. For example, make personal contact with your hand as you hold the client at a distance, make eye contact, and tell the client
that while physical reaching out is positive and welcome, you cannot allow it [10]. The ACA ethics code prohibits sexual and/or romantic coun- selor/client interactions or relationships with former clients, their romantic partners, or their family members for a period of five years following the last professional contact. This prohi- bition applies to both in-person and electronic interactions or relationships [4]. The APA ethics code indicates that this period should be “at least two years after cessation or termination of therapy,” and that “psychologists do not engage in sexual intimacies with former clients/patients even after a two-year interval except in the most unusual circumstances” [3]. Mental health professionals who choose to engage in relationships with former clients have the burden of demonstrating that there has been no exploitation, in light of all relevant factors [3]. Factors to consider include the amount of time passed since termination of therapy; the client’s personal history and mental status; the likelihood of an adverse impact on the cli- ent; and statements or actions made by the counselor during therapy suggesting or inviting a possible sexual or romantic relationship with the client [3]. Standards regarding sexual relationships and physical contact also are addressed by the NASW ethics code [5]: 1.09 Sexual Relationships (a) Social workers should under no circumstances engage in sexual activities, inappropriate sexual communications through the use of technology or in person, or sexual contact with current clients, whether such contact is consensual or forced. (b) Social workers should not engage in sexual activities or sexual contact with clients’ relatives or other individuals with whom clients maintain a close personal relationship when there is a risk of exploitation or potential harm to the client. Sexual activity or sexual contact with clients’ relatives or other individuals with whom clients maintain a personal relationship has the potential to be harmful to the client and may make it difficult for the social worker and client to maintain appropriate professional boundar- ies. Social workers—not their clients, their clients’ relatives, or other individuals with whom the client maintains a personal relationship—assume the full burden for setting clear, appropriate, and culturally sensitive boundaries. (c) Social workers should not engage in sexual activities or sexual contact with former clients because of the potential for harm to the client. If social workers engage in conduct contrary to this prohibition or claim that an exception to this prohibition is warranted because of extraordinary circumstances, it is social workers—not their clients—who assume the full burden of demonstrating that the former client has not been exploited, coerced, or manipulated, intentionally or unintentionally.
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