Managing Professional Boundaries _ ____________________________________________________________
All professional codes of ethics are clear that maintaining the boundaries of confidentiality is crucial for establishing trust in the therapy relationship. There are times where this boundary must be crossed, for example in situations of child abuse or neglect. Each state has their own set of laws govern- ing situations of mandated reporting and the ethical clinician stays up to date on those laws. That information should be clearly outlined in the initial informed consent agreement at the beginning of the therapy relationship. It should also be reviewed and discussed if a situation arises where potential disclosure is an issue. Other areas where there is the potential for crossing the confi- dentiality boundary include group treatment, family treatment, and couples counseling. In these situations, it is important for the counselor to address the limits and boundaries of confi- dentiality with every person involved in the relationship and, again, this should be clearly described in the initial informed consent documents. TELEHEALTH AND BOUNDARIES A discussion about boundaries and ethics would not be complete without addressing telehealth services. Telehealth is an emerging area of practice which has become increasingly popular. In addition to convenience, it allows for the provision of services to persons who might otherwise be unable to access them. Persons who live in remote areas, persons who have no transportation, or persons who are physically homebound are some populations which have benefitted. A thorough discus- sion of telehealth is beyond the scope of this course. Every state and jurisdiction and every professional licensing board has developed laws and regulations regarding the practice of telehealth. Providers are encouraged to become familiar with those if they intend to engage in telehealth services since there is the potential for boundary crossings or boundary violations in the use of telehealth technology, mainly as they relate to confidentiality and cross-state services. • NASW (2021) states that social workers who provide electronic social work services should be aware of cultural and socioeconomic differences among client’s use of and access to electronic technology. (Standard 1.05). They should have the knowledge and skill to use the technology in a competent manner and their use of technology should comply with the laws governing its’ use (Standard 1.04). They should take steps to protect the confidentiality of electronic communications and should use safeguards to protect confidentiality (Standard 1.07).
• ACA (2014) states that counselors actively attempt to understand the evolving nature of distance counseling and they make every attempt to protect confidentiality when using distance counseling technology (Section H) and make every attempt to ensure confidentiality and security. (Standard H.2.d). • NBCC (2023) states that counselors provide
telehealth services only if qualified, they follow legal requirements, they ensure that
communications are encrypted and secure, and they set clear boundaries with clients about the type and timing of telehealth therapy. They should provide the client with written information about the protection of confidentiality and security measures. (Standards 91-97). • AAMFT (2015) states that it is the therapist’s responsibility to choose technology platforms that adhere to the best practices related to confidentiality, quality of services, and applicable laws (Standard 6.3) and they ensure that they are well trained and competent to provide technology- assisted services. (Standard 6.6). • APA (2017) states that psychologists have a primary obligation to protect confidential information obtained through any medium (Standard 4.01) and has published guidelines specific to the practice of telehealth. Chenneville and Swartz-Mette (2020) discuss many of the ethical considerations that may be an issue when providing telehealth services. Among those is the boundary of con- fidentiality and the potential for its limits to be crossed or expanded. They note that in a telehealth situation there is the potential for outside parties to listen in on the therapy session, the therapists’ or clients’ comfort with the technol- ogy may impact confidentiality (e.g., being hacked), and the client themselves may be able to record the session without the therapist’s knowledge or consent. Stoll and colleagues (2020) reviewed databases for topics on ethics, online, and therapy. They also found that the most discussed disadvantages of using telehealth technology for therapy were the risks to the boundaries of privacy, confiden- tiality, and data security. Telehealth has become a common modality for providing clini- cal services and is likely to only continue to expand. Barnett (2019) offers several recommendations for counselors who provide telehealth services as a way of maintaining safe and ethical boundaries. • Counselors should apply all relevant ethics code standards, regulations, and guidelines just as they would for in-person therapy.
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