Setting Ethical Limits: For Caring and Competent Professionals ______________________________________
Humanistic theorists openly embrace counselor self-disclosure, asserting that such interventions demonstrate counselors’ genuineness and positive regard for clients [83]. It is not surprising that professionals with behavioral and cognitive orientations view professional self-disclosures positively, especially when these interventions are intended to serve as a model for client self-disclosure [84]. And there will be times that self-disclosure is helpful in therapy. For example, it may serve as a vehicle for transmitting feminist values, equalizing power in the therapy relationship, facilitating client growth, fostering a sense of solidarity between counselor and client, helping clients view their own situations with less shame, encouraging clients’ feelings of liberation, and acknowledging the importance of the real relationship between counselor and client. It also may enable clients to make informed decisions about whether or not they choose to work with a counselor [84]. According to one study, the content areas clinical social workers felt most comfortable self-disclosing about were loneliness, relationship status, aging, and other developmental issues of adulthood. Many talked freely about their marital status, the composition of their families, their parenting, their education, and their work. The most significant content area for sharing was grief work around significant losses either through separation, divorce, or death [85]. In these cases, counselor self-disclosure can help clients feel less alone and can normalize an emotional experience. It can give a client hope to learn that a trusted counselor has gone through the same situation. Cautions Regarding Self-Disclosure The power differential in the therapeutic relationship gives the professional access to a great deal of information about the client, which is transmitted in a one-way direction from client to counselor. Occasionally, a client will ask personal questions of the counselor. The questions may arise simply out of curiosity, but they also may arise when a client is attempting to gain a feeling of control, as seen in individuals with personality disorders. Personal questions also may signal a client’s wish to avoid feeling uncomfortable with emerging feelings/thoughts. Acknowledging and showing compassion for the client’s curiosity while maintaining professional boundaries will satisfy most clients. While it is normal for clients to be curious, it is important to remind them that they are the focus of session. Gently redirect the conversation with comments such as, “Let’s get back to you,” or “What were you thinking or feeling before you asked me about myself?” It is important that professionals keep their sharing limited, even when the client asks for them to self-disclose. No matter how on guard one is, there will be times when personal information makes its way to clients. Accidental self- disclosures may include extra-therapeutic encounters, slips of the tongue, or public notices of events or lectures. Personal aspects of the counselor’s life may come to light if he or she calls a client by another client’s name, a newspaper prints an obituary of the counselor’s spouse, or the counselor is seen entering a place of worship [86]. Most clients who learn a bit
of personal information about their counselor will mention it only to express care or concern, as when they learn of a death. Clients are generally satisfied with a brief acknowledgement of the disclosure and an appreciation for the client’s expressed feelings about it. As stated, mental health professionals’ primary concern is to avoid burdening or overwhelming clients. Professionals should generally avoid using disclosures that are for their own needs, that remove the focus from the client, that interfere with the flow of the session, that burden or confuse the client, that are intrusive, that blur the boundaries between the professional and client, or that contaminate transference [84]. TECHNOLOGY AND DISTANCE THERAPY We live in a rapidly changing world, especially where technology is concerned. In the past, therapy was offered only through in-person interaction in an office setting. Then, gradually, some professionals began to offer telephone sessions. Today, counseling is offered through video conferencing and other forms of telepsychology, and paper client records are being replaced with electronic records. Competent counseling includes maintaining the knowledge and skills required to understand and properly use treatment tools, including technology, while adhering to the ethical code of one’s profession. The APA has created guidelines to address the developing area of psychologic service provision commonly known as telepsychology [87]. The APA defines telepsychology as the “delivery of psychological services using telecommunication technologies…Telecommunication technologies include, but are not limited to synchronous (i.e., live and real-time interaction, e.g., videoconferencing, audio-only telephone) and asynchronous (i.e., store-and forward, non-live; e.g., text, email, messaging program, data-tracking smartphone applications) methods of healthcare-related communication and transmission of healthcare-related information. Transmitted information may include text, image, audio, interactive videoconferencing, remote patient monitoring, or other data related to patient care” [89]. The APA guidelines are informed by its ethics code and record-keeping guidelines as well as its guidelines on multicultural training, research, and practice. The guidelines allow that telecommunication technologies may either augment traditional in-person services or be used as stand-alone services. However, the guidelines are intended to “help psychologists apply best professional practices when using telecommunication technologies” and not to “contravene any limitations set on psychologists’ activities based on ethical standards; federal, state, provincial, and territorial laws; and other organizational regulations” [87]. When one set of considerations may suggest a different course of action than another, the professional should balance them appropriately, with the aid of the guidelines, while holding to all current legal
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