7. Refer to a colleague any client that you feel incompetent to treat or that you do not feel you could work effectively with. 8. Pay attention to informed consent for any planned or obvious boundary crossing. 9. Keep notes on any planned boundary crossing describing why, in your clinical judgment, you feel the boundary crossing is necessary and will be helpful to the client. Finally, Levine and Courtois (2021) point out that not all boundary crossings are planned. When a provider does something outside of the established boundaries, when they make a mistake or break a parameter, it should be brought to the client’s attention and discussed. Sometimes a simple apology is all that is needed, but the feelings and response of
the client should be elicited and appreciated. This can repair the relationship and foster trust and understanding. Clinical Consideration : It is clear that to cross or not to cross a boundary at any particular time in therapy requires careful thought and consideration by the therapist. The therapist must take into consideration the client’s history, culture, values, and diagnosis. Any crossing that is considered should be part of a well-constructed and clearly defined treatment plan that is for the benefit of the client. It should be discussed in full with the client and should be clearly documented in the client’s chart.
BOUNDARY CROSSING: NONSEXUAL DUAL OR MULTIPLE RELATIONSHIPS
Dual or multiple relationships have been a primary area of focus when discussing boundary issues. These describe situations in which the counselor has another relationship with a current or former client outside of the therapy one. There is a secondary relationship between the clinician and the client in addition to the therapy one. Providing therapy to a client’s relative or friend, socializing with a client, or loaning money to a client are examples. Multiple relationships also occur when the therapist takes on more than one role with a person, for example, counselor and supervisor or counselor and business partner. There is an inherent power differential in these relationships that creates the potential for harm or exploitation. The dual relationship could impair the counselor’s judgment or objectivity, and the client could misunderstand the nature of the relationship. While all multiple relationships are boundary crossings, they are not necessarily boundary violations. As previously discussed, Magiste (2020) reported that a survey spanning 28 years of ethics complaints for a profession found that, although continuing education audit requirements compromised the largest number of complaints, this was followed closely by complaints related to the nonsexual boundary issue of engaging in a dual relationship. It is no surprise, then, that all of the ethics codes specifically address the issue of dual or multiple relationships in the course of the therapeutic relationship and may also define the type of relationship that is cautioned against. ● ACA (2014) states that counselors avoid extending the boundary of the therapy relationship to include other roles (Standard A.6.b). Prohibited non-counseling relationships include engaging in counseling with persons with whom they have had a previous sexual or romantic relationship or with friends or family members, as it could impair objectivity. Personal virtual relationships with current clients are also prohibited (Standard A.5). ● NASW (2011) notes that dual relationships occur when the social worker relates to the client in more than one way, whether professional, social, or business and these relationships can occur simultaneously or consecutively. They should not engage in dual or multiple relationships with clients or former clients in which there is a risk of exploitation or potential harm to the client. If a multiple relationship is unavoidable, the social worker takes steps to protect the client and is responsible for setting clear, appropriate, and culturally sensitive boundaries (Standard 1.06). ● AAMFT (2015) states that multiple relationships include but are not limited to business or close personal relationships with a client or the clients’ immediate family. Therapists make every effort to avoid multiple relationships that could impair professional judgement or increase the risk of exploitation (Standard 1.3). ● NBCC (2023) states that counselors should avoid counseling relationships with individuals with whom they have another relationship with such as a community connection, friendship, or work relationship. They strive to avoid multiple relationships with clients except in cases where it is culturally
appropriate or therapeutically relevant. If an unforeseen multiple relationship happens, the counselor is to discuss the potential effects with the client and make attempts to resolve the situation, which may include termination of the therapy relationship and referral to another provider (Standard 22). They should not enter into a non-counseling relationship with a former client for at least 5 years after the last professional contact (Standard 23). ● APA (2017) does not specifically define persons but broadly states that a multiple relationship occurs when the clinician “Is in a professional role with a person and at the same time is in another role with the same person,” “At the same time is in a relationship with a person closely associated with or related to” the client or “Promises to enter into another relationship in the future” with the client or person closely related to the client. Psychologists do not enter into a multiple relationship if it could reasonably be expected to impair the psychologist’s objectivity, competence, or effectiveness or if it otherwise risks exploitation or harm to the client. If the psychologist finds that a potentially harmful multiple relationship has arisen, they take steps to resolve it keeping the best interests of the client in mind (Standard 3.05). As implied in these guidelines, there are many types of relationships which fall under the definition of multiple relationships. Examples include social, when the therapist and client are also personal friends; professional, when the therapist and client work together in the same organization; business, when the therapist shops at a store owned by the client; community, when the therapist and client attend the same church or community group; or romantic, when the therapist and client are intimately involved. Despite these guidelines advising against multiple relationships, they may not always be avoidable. Small towns, small communities, or limited-in-size groups may make it nearly impossible to avoid having a relationship with a client outside of the therapy room. For example, in a small community the therapist may attend the same church as the client. In a rural area with one physician, the therapist who is a patient of the physician may provide therapy services to the nurse who works at the doctor’s office. Brownlee and colleagues (2019) surveyed rural social work practitioners and found that 90% of the therapists felt that dual relationships in rural communities are inevitable and common. Szumer and Arnold (2023) note that in rural environments it is inevitable that the healthcare provider’s personal relationships will cross over with their professional relationships either with the client or with persons close to the client. They argue that these encounters are just that— encounters—and are not ongoing involved relationships. They suggest the term “overlapping” relationship rather than dual or multiple relationships to differentiate them. They recommend that the provider reflect on whether the overlapping relationship is harmful to the client in any way, whether it could damage the therapeutic relationship in any way, whether any professional codes or regulations are applicable to the situation, and whether
EliteLearning.com/Psychology
Book Code: PYFL4024
Page 224
Powered by FlippingBook