Code of Ethics for Counselors and Marriage and Family Therapists __________________________________
Case 4: Sexual Boundary Violation A therapist had delivered services to a client for two months and felt an attraction to her. He decided to invite her to go with him to a presentation on autism because her nephew had been recently diagnosed with the disorder. The client believed that it was not a date but rather an educational event, so she accepted. After the lecture, they went to dinner at the invita- tion of the therapist. When the client went to the next therapy session, she was given a DVD for the nephew that was produced by the speaker from the presentation. Following a subsequent therapy session, they again went to dinner, and after a few drinks, they returned to the client’s house, where they engaged in sexual intercourse. The relationship continued for a month and ended when the therapist started dating a previous girlfriend again. The client was hurt and angry. She ended the therapy sessions and brought a malpractice suit against the therapist on the grounds that he was unprofessional and that the relationship violated professional boundaries. She claimed that the relation- ship caused her such mental distress that she was unable to sleep, which subsequently affected her work. The review board ruled in favor of the client and awarded a large damage award as a result of her civil malpractice complaint. Analysis The therapist has the burden of proving that no exploitation took place in relation to the client’s mental status and sever- ity of their presenting issues, the ability to comprehend the risk, a level of independence, and the autonomy to act in their best interest. As a professional with inherent power in the relationship due to the potential to coerce or influence a client, therapists may have difficulty defending themselves against a claim of sexual misconduct Any diagnosis, such as depression, previous abuse, or various personality or emotional disorders, suggests vulnerability or susceptibility to exploitation and would influence the case against a therapist The therapist or counselor must, in all ways, put the client’s welfare above his or her own. Sexual relationships with current, former, or potential clients are always an ethical violation.
The therapist observed that M.K. showed symptoms of severe anxiety when he spoke of the woman. In a subsequent session, M.K. told the therapist that he once fired a BB gun at her car as she drove by his house. M.K. stole a prescription pad from the therapist and attempted to forge his signature in an attempt to purchase 30 Xanax pills. The pharmacist noticed that M.K. was acting suspiciously and, because of his age, called the therapist. The therapist told the pharmacist to disregard the prescription, and M.K. went home. He later stole a gun and shot the young woman to death. The therapist had attempted to reach M.K. by phone to discuss the stolen prescription forms but did not reach him before the woman was shot. The woman’s father had heard of the Tarasoff case, and the family hired an attorney to bring a civil suit against the therapist. The suit charged him with the wrongful death of their daughter and his failure to warn and protect her. The therapist hired an attorney who argued to dismiss the suit claiming that the Tarasoff principle should not apply in New Jersey based on the following: • The ability to predict danger is unreliable. • Violating the client’s confidentiality would have interfered with effective treatment. • Instituting the Tarasoff principle might deter therapists from treating potentially violent patients. • A ruling on the Tarasoff principle could lead to unwarranted commitments to institutions. Analysis The court rejected all these arguments and declined to dismiss this case. The court instead ruled that the duty to warn is valid under New Jersey law. The court decision stated that even though therapists could not be expected to accurately predict danger or harm in 100 percent of the situations, they have the ability to make a professional judgment in the relationships of the client with others. This therapist observed several warning signs, and the client’s own statements and actions of a violent nature should have provided the therapist with enough evi- dence to decide that a warning concerning the potential of danger was in order. The court made an analogy and compared the situation with the responsibility to warn communities and individuals about carriers of a contagious disease. The court stated that the cli- ent/therapist confidentiality must be secondary to the greater welfare of the community. In cases of imminent or potential danger, the therapist has the duty to warn. The therapist faced the jury and was not held liable for damages, but the Tarasoff principle of duty to warn and protect was adopted in New Jersey.
DUTY TO WARN Case 1
M.K. was a 15-year-old client of a New Jersey psychiatrist for two years. The client was open with the therapist about his use of illegal drugs and his violent thoughts about a fantasy to threaten people with a knife to control and rob them. He also told the therapist about his sexual relationship with a 20-year-old neighbor. It was clear that he had a strong emo- tional attachment to the young woman; however, M.K. often expressed his anger and jealousy that the woman was dating other men.
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