Self-Assessment Quiz Question #3 When considering accepting a client’s gift, the therapist should: a. Consider the timing of the gift b. Consider the monetary value of the gift c. Consider the client’s intent for giving the gift d. All of the above
BOUNDARY CROSSING: BARTERING
Bartering is another area that poses a potential multiple relationship and boundary crossing. Bartering is considered the exchange of goods, services, or other nonmonetary renumeration from clients in return for therapy services. It is also part of the societal norm in many cultures and communities. Bartering is a boundary issue as it is outside of the normal therapy parameters for payment (self-pay, insurance). The exchange of specific goods is a boundary crossing. The bartering for the exchange of services, however, also creates a secondary relationship outside of the therapeutic one and therefore also constitutes a dual relationship that must be navigated. Bartering is not specifically prohibited by professional codes or regulations in limited circumstances, provided that it is not clinically contraindicated and that it does not result in an exploitative arrangement. However, it is strongly discouraged by all professional ethics codes. ● APA (2017) states that psychologists may barter only if it is not clinically contraindicated and the resulting arrangement is not exploitative (Standard 6.05). ● NASW (2021) states that social workers should avoid accepting goods or services as payment for professional services because bartering arrangements create the potential for conflicts of interest, exploitation, and inappropriate boundaries. This code specifically states that bartering should take place in very limited circumstances and only when it is an accepted practice among professionals in the local community and is negotiated without coercion (Standard 1.13). ● ACA (2014) limits counselors to barter arrangements only if they do not result in exploitation and are an accepted practice in the community. The cultural implications must be discussed, and there must be a clear written contract documented. This code also adds that the barter arrangement must be requested by the client, inferring that it is not acceptable for it to be suggested by the counselor (Standard A.10.e). ● AAMFT (2015) states that the client must request the arrangement. The bartering arrangement must not be exploitative, the professional relationship must not be distorted, and there must be a clear written contract. ● NBCC (2023) states that counselors generally do not accept goods or services in return for providing counseling services. They enter into a bartering arrangement only when no other referrals are possible or appropriate, the arrangement is discussed with the client in advance, the barter exchange is of equivalent value, the exchange does not place the counselor at an unfair advantage, the arrangement is not harmful to the client, and it is documented in the counseling services agreement (Standard 20). The ethics codes of these professions specifically address the issue of bartering since bartering constitutes a boundary crossing and it could therefore be exploitative due to the power disparity between therapist and client. The primary question is whether accepting goods or services in exchange for therapy services increases the potential for conflict of interest or exploitation or harm to the client.
On the surface, entering into a bartering agreement may seem beneficial at times, for example, when the client is experiencing hard economic times. Entering into a bartering agreement, however, can potentially lead to problems in the therapeutic relationship. What happens if the client does not fulfill their part of the barter? What if services by either party do not meet the other parties’ expectations for quality or timeliness? A better option when the affordability of therapy services is an issue may be referral to a lower fee option or use of a sliding scale fee schedule. The issue of exploitation becomes apparent when values for the barter are assigned. Is the value for the therapist’s time and expertise placed at a higher level than the client’s part of the barter? Who sets those values? The risk of exploitation is quite high and suggests that the barter arrangement could easily move into the realm of a boundary violation rather than a nonharmful arrangement. When considering expanding a boundary to include bartering, the trading of goods or services which have known cost estimates has been suggested. Therapists have standard fees that they charge—a known cost. Providing therapy services at that fee rate in exchange for a service that also has a known cost may appear to be an equitable arrangement. For example, the therapist could provide therapy at the normal fee rate for as many sessions as necessary to equal the known cost of a house painting job. While on the surface this seems to be a fair agreement, this arrangement commits the therapist and client to a future number of therapy sessions that may not be needed. It may cross into the realm of exploitation if the therapist works on a sliding scale and would have charged the client a lower fee rather than full fee. It also creates a dual relationship situation, a relationship that is secondary to, and outside of, the therapy one. Clinical Consideration :All bartering arrangements are, at the very least, a boundary crossing. If the clinician decides to proceed with a barter arrangement after considering all of the factors involved, a detailed written contract that clearly protects the client’s welfare and is documented in the client’s chart is strongly recommended even if it is not specifically required by the clinician’s professional code of ethics. Bartering by definition requires negotiation. Negotiating with a client who may be in distress at the time becomes a questionable situation. Even under the best of circumstances there could be misunderstandings and unintentional harm to the client. Bartering may lead to loss of objectivity on the part of the therapist, for example if the client wants to barter a service or good that the therapist does not need or want. While bartering of goods likely constitutes an expansion or crossing of therapy boundaries, bartering of services always creates a dual relationship. The therapist has entered into a service agreement with a client that takes place outside of the therapy room, so great caution is needed if the arrangement is being considered.
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Book Code: PYTX1325
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