Autonomy/Justice Clinical Consideration : Keeping appointments, starting on time, and remaining attentive in the therapy session are basic examples of fidelity, as is maintaining confidentiality to foster trust. Clinicians have a responsibility to be fair and impartial and to treat people equally. They respect the dignity and worth of clients and respect individual, cultural, and role differences. They work to ensure that all clients have access to resources and services. ● APA (2017)—Clinicians have a responsibility to be fair and impartial and to treat people equally. They remain aware of their personal potential biases and boundaries of competence. They respect the rights of individuals to privacy, confidentiality, and self-determination (Principles D, E). ● NASW (2021)—Social workers challenge social injustice and pursue social change focused primarily on issues of poverty, unemployment, and discrimination, and they seek to promote sensitivity to oppression. They treat each person in a caring and respectful manner, and they stay aware of individual differences and cultural and ethnic diversity (Value: Social Justice). ● ACA (2014)—Counselors work to help the client foster control over the direction of their life. They treat individuals equitably and foster fairness and equality (Client Welfare). ● AAMFT (2015)—Marriage and family therapists provide services to persons without discrimination. They foster diversity, equity, and excellence in clinical practice (Responsibilities to Clients). ● NBCC (2023)—Counselors strive to be sensitive to differences in attitudes and culture. They provide The concept of boundaries in the therapeutic relationship has received increasing attention over the years and is addressed in most of the laws, regulations, and ethics codes of the various professions. However, these tend to focus on the more extreme violations with less attention being paid to the subtle and less obvious boundary issues that can cause difficulty for clinicians. Boundaries in professional relationships have been defined in many ways. According to the American Psychological Association, (APA 2023) boundary issues are “Ethical issues relating to the proper limits of a professional relationship between a provider of services and his or her patient or client, such that the trust and vulnerability of the latter are not abused.” Essentially, boundaries are the line between professional and personal. The fundamental purpose of boundaries in therapy is to create and maintain clear expectations for the client in order to provide the client protection from harm. When boundaries are not respected, there is risk of the therapist starting to work in their own best interest, which could lead to exploitation or harm to their client. Despite the importance of boundary knowledge, Chen and colleagues (2018) point out that education about boundaries in training and education programs tends to take on an abstract, theoretical quality and does not address the day-to-day dilemmas that most practitioners face. The terms “boundary crossings” and “boundary violations” are often used interchangeably, but the literature strives to separate the terms. Boundary crossings refers to any deviation from traditional practice which are harmless to the client and may also at times be therapeutic (Appel, 2023). It refers to situations where a boundary is crossed in order to meet therapeutic goals, and it does not harm the client
services to all of those in need, utilize available resources, and advocate for the expansion of resources in underserved communities. They avoid discrimination, oppression, or any form of social injustice (Core Values). Barnett (2019) emphasizes that familiarity with one’s professional ethics codes is necessary but not sufficient for ensuring ethical practice. Ethics codes are by design general guidelines and cannot address every possible ethical dilemma or challenge. Some aspects provide clear and specific behavioral guidance, while many of the standards are broad and vague. It then becomes difficult at times to navigate real-life dilemmas within the boundaries of the codes. Barnett suggests that ethics codes represent the minimum standards for ethical behavior, the ethical floor, and that providers should instead focus on aspirational standards: Focus on doing your best at all times for the benefit of the client and others. He reviews the core principles that transcend all disciplines and also adds self-care as an essential obligation. He argues that without appropriately attending to therapist functioning and well-being, over time the therapist’s ability to effectively implement the core principles becomes jeopardized. Self-Assessment Quiz Question #1 Which ethical principle states that a clinician has a responsibility to be fair, impartial, and treat people equally? a. Beneficence or damage the therapeutic relationship. Boundary crossings are not uncommon in day-to-day practice. The following are examples of common boundary crossings: ● Limited self-disclosure by the therapist to help establish rapport or normalize the client’s behavior. ● Extending the length of a session one time for a client in distress. ● Taking nonemergency phone calls between sessions. ● Accepting a minor gift from a client. ● Running into a client at the store or a public gathering. ● Temporarily reducing the session fee for a client who just lost their job. All of these situations deviate from traditional practice but are not necessarily harmful to the client. Not all boundary crossings lead to boundary violations, and some boundary flexibility allows for a response to an individual client’s needs at that time. A boundary violation is a more serious infraction. It is a deviation from practice which is harmful or exploitative of the client (Appel, 2023). A boundary violation moves the therapist out of the professional role; it tends to benefit the clinician more than the client; there is risk of harm to the client; it is often exploitative; and it violates professional ethical standards. When a boundary violation has occurred, the professional has engaged in a cognitive decision- making process that allowed a potentially harmful behavior to occur. This is not necessarily intentionally malicious behavior; it could have occurred from the professional being selfish, uninformed, or impaired. Nonetheless, the potential for causing harm to the client is great. Some potential consequences for the client can include the
b. Nonmaleficence c. Integrity/fidelity d. Autonomy/justice THE CONCEPT OF BOUNDARIES
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