____________________________________________ Professional Ethics and Law in California, 2nd Edition
Many times boundaries are crossed unintentionally, as when a practitioner becomes overly involved in a case with which she personally identifies. Or the worker may be expe- riencing life issues that make him or her more vulnerable to the attentions of a client. Mental health professionals have a responsibility to maintain competence in both the professional and emotional arenas. Regardless of the circumstances, the worker’s first responsibility is always to the client. There are also times when the intent of the professional is truly to be helpful—for example, buying merchandise from a client whose business is struggling or inviting a divorce recovery group client to a community function in order to help her broaden her social network. While some types of situations may not be considered unethical or illegal, the worker needs to carefully review his or her motivation and the potential consequences of each decision. Some helpful questions to ask are: • Would I do this for all my clients? • Am I doing this because I feel uncomfortable (e.g., saying no)? • Am I feeling at a loss to help the client any other way and thus feeling “I must do something” to feel competent? • How might the client interpret my gesture? • Am I doing this just for the client’s interest or also for my own interest? • What are all the potential negative outcomes? There will be occasions when you incidentally come into contact with a client, such as finding your client’s daughter is on the same soccer team as your child. Some practitioners go out of their way to live in a different community so the chances are minimal that this could happen. Others see that as overmanaging a potential situation that is unlikely to lead to harm for the client or colleague (as in the case of supervisees). 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 contradic- tory 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 super- visees 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 us.” 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 relation- ships are essential and include: 1. Protection of the Therapeutic Process: In the con- text of current clinical practice, “even minor bound- ary 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 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: Work- ers 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
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