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 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 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 Sexual misconduct Some states also have laws making sexual misconduct subject to lawsuits and even arrest. Practitioners need to be sure about the rules that apply to them and must be aware of how their behavior may be perceived by others. For example, Reid (1999) points out that in most situations consent will not be an effective defense against sexual misconduct allegations. The reasons Reid gives for a client’s ability to consent being called into question are: ● The fiduciary trust between clinician and patient. ● Exploitation of transference feelings. ● The right of the patient to expect clinical needs to be the overriding priority. ● Exploitation of the patient’s purported inability to resist the therapist’s influence. ● The alleged “power differential” between any patient and his or her clinician.
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. ● 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. 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. Recorded history of sexual misconduct travels back to the 4th and 5th centuries B.C. and includes the Hippocratic Oath that states, “I will abstain from intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free.” In contrast, Sigmund Freud flagrantly demonstrated sexual misconduct when he excused such behavior by his male colleagues. For example, Carl Jung, according to historians, became sexually involved with one of his patients by the name of Sabina Spielrein, a 19-year- old medical student. When corresponding with Freud, he stated, “the continued preservation of the relationship (with Sabina) could be rounded out only by sexual acts.” As Jung became more desperate when the affair became known he was reassured by his colleague, Freud. Freud wrote
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