The members of these groups often divulge information that is personal in nature and reveal areas of weakness or uncertainty. It is not an official therapy group but the leader is certified as a spiritual counselor with a theology degree. One day a new member joined the group who was a client of the therapist. The therapist felt uneasy and somewhat uncomfortable about his participation in front of the client and declined to discuss personal information with the group in front of the client. The therapist feared that his role in the group, which sometimes included social activities, would constitute a dual relationship with the client, which would be a boundary violation if he continued as therapist for the client. Analysis A dual relationship is one where multiple roles exist or overlap between a therapist and a client and consists of both professional and social roles (Riedell, 2005). Examples of dual relationships could include clients who interact, in a variety of roles, with the therapist outside of practice. Client roles may include students, interns, friends, family, colleagues, supervisors, employees, business partners, teachers, subordinates, or healthcare professionals who interact with the therapist. The practitioner must understand the concept of dual relationships and know that they alone are responsible and accountable for dual relationship that may result in boundary relationships that may harm the client or disrupt effective therapeutic relationships. A power differential often exists between the therapist and client in both settings so the practitioner must access the effects of dual relationships to ensure clear relationship boundaries. Interacting with a client in any capacity outside of the treatment room may lead to a more personal relationship. The nature of the activity will dictate whether or not a relationship results in one that leads to a boundary crossing or violation. As the massage profession’s nature initiates a certain level of intimacy, each role within dual relationships and levels of intimacy determine a course of action (Riedell, 2005). For example if the activity is a ballroom dancing class, that may involve a level of intimacy that could lead to inappropriate feelings on the part of one or both parties. These feelings would change the nature of the therapeutic relationship if they were continued in the treatment room and could lead to inappropriate behaviors from either party if professional boundaries are not maintained or reset. Switching roles, or dual roles, in the therapeutic relationship can lead to confusion and the possibility of transference or counter transference, and both parties are often tempted to continue developing a personal relationship rather than maintaining a professional atmosphere (Riedell, 2005). If this occurs, it could result in emotional harm to the client and at best would interfere with objectivity and the focus on effective therapy to attain client healthcare goals. In this case study the therapist must determine why the client entered the group to be sure that their motivation was not just to be closer to the therapist. The therapist would also have to consider how their disclosure of personal information in front of the client might affect the therapeutic relationship. Would the disclosures in the group impact the respect of the client, would it lead to empathy, sympathy, of pity that might enhance or hurt the therapeutic relationship and under mind the confidence of the client in the therapist’s professional ability. Again the words, “do no harm,” must always be considered when determining the course of action with clients both in and out of the treatment setting. Case study 8 The therapist had been working with a seventeen girl for a year following a car accident that caused a back injury. The teen felt comfortable with the therapist and they had built a trusting
Massage therapists are not prohibited from all social contact in the code of ethics so they must make decisions based on self- assessment and the retention of clear boundaries to be sure all activities are legal and ethical. It is up to the therapist to evaluate the potential risks involved in fostering a dual relationship. When evaluating the risks, consider the following: ● What is the nature of the activity? ● Who initiated the activity? ● Is the activity beneficial to the client? ● What is the level of intimacy? ● Is there a potential for boundary crossing? ● What is the potential impact of the power differential? ● Who is accountable for what in the relationship? ● What is the relative maturity level? ● What are the consequences of participation and non- participation? ● What are the risks to the client, therapist, practice or profession? ● Would both parties be comfortable with public knowledge of the relationship? ● Does it best serve the client or the therapist? (Riedell, 2005) For example, the therapist has a car and a client who is an auto mechanic, which appears to be a mutually beneficial dual relationship at first. Before initiating this dual relationship, consider possible scenarios where the power differential may reverse: ● What if the mechanic does a poor job? ● What if the mechanic never shows up on time and causes the therapist to miss appointments? ● How might this situation spill over into the treatment room? ● After the car was supposedly fixed, would it be tempting to give a below standard treatment if the automobile problem resurfaced? (Riedell, 2005) Professional ethics require accountability to do no harm and dictates the obligation to help clients to the best of our ability. Nina McIntosh, author of The Educated Heart, suggests asking the following questions to determine if any action taken is ethical: ● Does the action keep the focus on safety and well-being of the client? ● Are you being respectful of the power imbalance and/or the transference effect? Or are you using this power imbalance to your own benefit? ● Does the action create a dual relationship and make the therapeutic boundaries less clear? ● Does the action remain within the original contract with the client or does it exceeding either the area of expertise or the client’s informed consent? ● Does the action create a safer environment for the client or detract from it? ● Could the action lead to future problems in the therapeutic relationship? ● Does the action establish a sense of safety and reassurance, or it could it make clients feel uneasy, apprehensive and uncomfortable? (McIntosh, 2016) It cannot be stressed enough that appropriate boundaries, in terms of the type of interaction, setting, level of personal involvement and intimacy, and risk and benefits to clients, must be maintained at all times. These must be communicated and agreed upon with clients during the initial contact and revisited as change dictates, to preserve an ethical therapeutic relationship. Review Standard III on Confidentiality and Standard V on Roles and Boundaries.
therapeutic relationship. During a visit she confided to the therapist that she was pregnant and begged the therapist not to tell her parents because they would try to force her to have an
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