_____________________________________________________________ Managing Professional Boundaries
• They should remain current on the research literature for telehealth effectiveness in the treatment of various mental health concerns. • They should become competent in the use of technology and the safeguards necessary to protect confidentiality. • They should keep their clients’ best interests in mind when deciding if telehealth is the most appropriate way to meet their treatment needs. They should consider options and alternatives as well as the potential risks and benefits of each. • They should assess each prospective client’s treatment needs fully, including diversity factors such as culture and language, when considering use of telehealth. • They should treat all online relationships with clients as similar to in-person therapy relationships. • They should address the use of telehealth technology and limits and boundaries of this form of therapy with clients at the outset of treatment. Clinical Consideration : Provision of telehealth services poses unique risks to the boundaries of privacy and confidentiality. Providers and clients should have a clear understanding of the risks and benefits of the services, and they should have knowledge about security issues prior to using this modality. • They should be knowledgeable about relevant emergency resources available in the clients’ community in the event of a crisis or emergency.
relationship with former clients even after a 2-year waiting period except in unusual circumstances, and if they do, they bear the burden of demonstrating that there has been no exploitation. (Standards 10.05–10.08). • NASW (2021) states that under no circumstances do social workers engage in sexual activity, inappropriate sexual communication, or sexual contact with current clients regardless of whether the contact is consensual or not. They do not have sexual contact with the client’s relatives or those close to the client. They do not engage in sexual activity with former clients, and if they do, they bear the full burden of proof that the client was not exploited, coerced, or manipulated. Social workers do not provide services to individuals with whom they have had a prior sexual relationship (Standard 1.09). • NBCC (2023) states that counselors will not engage in any form of sexual or romantic contact with a client or former client for at least 5 years following termination of counseling services. (Standard 24). • ACA (2014) states that in-person or electronic sexual or romantic relationships with current clients, their partners, or clients’ family members are prohibited. They are prohibited from providing counseling services to previous romantic or sexual partners. They are prohibited from having a romantic or sexual relationship with a former client or their family members for 5 years after the termination of therapy. This applies to in-person and electronic modalities (A.5.a–A.5.c). • AAMFT (2015) states that sexual intimacy with current or former clients or members of the client’s family system is prohibited (Standards 1.4-1.5). Despite these very clear professional standards prohibiting sexual relationships, these serious boundary violations do occur. Jacob and colleagues (2022) reviewed counselor liability claims over a 5-year period ending in 2019 and found that 43.9% of all closed claims were related to sexual/romantic relationships with current clients or their family members, sexual/romantic relationships with current supervisees, and sexual/romantic relationships with former clients or their fam- ily members before the mandated waiting period. Vesentini and colleagues (2022) surveyed therapists about the frequency of intimate feelings related to friendship and sexuality on the part of the therapist toward a client. They found that 70% of respondents had felt attraction toward a client at some point in their career, and 70% reported emotionality toward a cli- ent, for example, feelings of sympathy. However, they found that starting a sexual relationship with a current or former client was infrequent at 3%, and starting a friendship after therapy terminated was more common at 13.4%. Jacob and colleagues (2022) reviewed historical research data and found
BOUNDARY VIOLATIONS
SEXUAL MISCONDUCT Sexual relationships with clients at any level are unequivo- cally unethical, they are firm boundary violations, and they are illegal under licensing laws in all states. All therapists are instructed during their education and training that sexual contact with current clients is prohibited without exception. Sexual misconduct can range from subtle uncomfortable behaviors to those that are blatant, coerced, manipulative, physically intrusive, and highly traumatic and can include comments, looks, invasive touching, sexual contact, and rape (Steinberg et al., 2021). Every profession’s code of eth- ics addresses this behavior as it has clear potential for harm, trauma, and exploitation. • APA (2017) prohibits sexual intimacy with current clients or individuals who are close relatives, guardians, or significant others of current clients, and therapists cannot terminate therapy to circumvent the prohibition. They do not accept
as clients those with whom they have had a sexual relationship. They do not enter a sexual
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