The appropriateness of relationships with clients is often debated across the profession. The unique service settings and roles assumed by workers often contrast with the traditional clinical approach to human service. Applying strict rules around relationships can appear excessive and/or contradictory with sound mental health practice. A worker, for example, may work in a small, isolated community that would expect its community members to share in social customs such as family meals and weddings. Ethical guidelines recommend giving students and supervisees guidelines to guarantee client protection instead of blanket advice to avoid dual relationships altogether (Boland-Prom & Anderson, 2005). Freud and Krug (2002b) also feel that “overcorrecting a problem, as is a frequent tendency in our society, sometimes escalates the very transgressions against which the new rules are to protect U.S..” While necessary and healthy debate continues, practitioners must, no matter what their scope of practice, seek guidance and input from a variety of sources to make good decisions around boundary issues. There are some areas where clear rules about dual relationships are essential and include: 1. Protection of the therapeutic process : In the context of current clinical practice, “even minor boundary trespasses can create unwarranted expectations.” Transference and countertransference issues are present and cannot be underestimated. According to Freud and Krug (2002b), “The mystique of the tightly boundaried, hierarchical therapeutic relationship heightens transference phenomena.” For example: Mark, a mental health counselor, suspected that his therapeutic alliance with a depressed young woman had turned a corner when she reported feeling less hopeless and more energized. She gratefully acknowledged his assistance and stated that she was planning to return to college and become a therapist. Mark was careful to point out that it was his client’s own work that facilitated her recovery. 2. Client protection from exploitation : A clinician may be tempted to meet personal sexual, financial, or social needs with persons who may be particularly vulnerable to exploitation. Ethical guidelines serve to protect clients from exploitation. For example: Jeff, a psychiatrist, received a referral for a patient who was severely depressed. Most of his patients were fairly wealthy and Jeff was impressed that his new patient had a good deal of money as well. As time went by, he Sexual harassment In1980 the EEOC (Equal Employment Opportunity Commission), the agency that enforces Title VII, first defined sexual harassment as a form of sex-based discrimination and issued guidelines interpreting the law. These guidelines define unlawful sexual harassment as: Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature, when: ● Submission to such conduct is made either explicitly or implicitly a term or condition of an individual’s employment. ● Submission to or rejection of such conduct by an individual is used as the basis for employment decisions affecting such individual, or ● Such conduct has the purpose or effect of unreasonably interfering with an individual’s work performance or creating an intimidating, hostile, or offensive working environment.
insisted that the patient continue daily sessions, even though the man was clearly improving and no longer needed intense intervention. 3. Protection from potential legal liability : Workers are concerned about legal liability, and careful adherence to the boundary specifications may protect clinicians from malpractice suits. For example: Kim, a new clinical social worker, was interested in practicing “progressive” forms of therapy. One practice she’d adopted emphasized focusing on empowerment issues for survivors of incest. Kim demonstrated a lapse in judgment when she encouraged a vulnerable young client to confront a relative regarding retrieved sexual assault memories, even though the client herself was not sure the memory reflected an actual event. Ultimately, it is the mental health professional’s responsibility to establish appropriate and clear boundaries for clients; doing so often prevents issues from surfacing in the first place. The worker must not underestimate the importance of expectations; respecting the client means together creating a safe relationship where boundaries and expectations are unambiguous and openly discussed. To further minimize possible harm to all parties – the client, the worker, the employer, etc. – the following risk management protocols to address boundary issues are suggested: 1. Be alert to potential or actual conflicts of interest. 2. Inform clients and colleagues about potential or actual conflicts of interest; explore reasonable remedies. 3. Consult colleagues and supervisors and relevant professional literature, regulations, policies, and ethical standards to identify pertinent boundary issues and constructive options. 4. Design a plan of action that addresses the boundary issues and protects the parties involved to the greatest extent possible. 5. Document all discussions, consultation, supervision, and other steps taken to address boundary issues. 6. Develop a strategy to monitor implementation of an action plan (with clients, colleagues, supervisors, and lawyers). Sexual Relationships, Physical Contact, Sexual Harassment, and Derogatory Language Ethical mental health practice limits sexual relationships with clients, former clients, and others close to the client; physical contact where there harassment; and the use of derogatory language in written and verbal communication to or about clients. In mental health practice, sexual harassment can take many forms, including offensive or derogatory comments, sexually oriented jokes, requests or demands for sexual favors, leering, visual displays depicting sexual imagery, innuendos, pinching, fondling, and impeding someone’s egress. Workers should not sexually harass supervisees, students, trainees, or colleagues.
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Book Code: SWNY1224
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