For example, the therapist has a car and a client who is an auto mechanic, which appears to be a mutually beneficial dual relationship at first. Before initiating this dual relationship, consider possible scenarios where the power differential may reverse: ● What if the mechanic does a poor job? ● What if the mechanic never shows up on time and causes the therapist to miss appointments? ● How might this situation spill over into the treatment room? ● After the car was supposedly fixed, would it be tempting to give a below standard treatment if the automobile problem resurfaced? (Riedell, 2005) Professional ethics require accountability to do no harm and dictates the obligation to help clients to the best of our ability. Nina McIntosh, author of The Educated Heart, suggests asking the following questions to determine if any action taken is ethical: ● Does the action keep the focus on safety and well-being of the client? ● Are you being respectful of the power imbalance and/ or the transference effect? Or are you using this power imbalance to your own benefit? ● Does the action create a dual relationship and make the therapeutic boundaries less clear? ● Does the action remain within the original contract with the client or does it exceeding either the area of expertise or the client’s informed consent? ● Does the action create a safer environment for the client or detract from it? ● Could the action lead to future problems in the therapeutic relationship? ● Does the action establish a sense of safety and reassurance, or it could it make clients feel uneasy, apprehensive and uncomfortable? (McIntosh, 2016) It cannot be stressed enough that appropriate boundaries, in terms of the type of interaction, setting, level of personal involvement and intimacy, and risk and benefits to clients, must be maintained at all times. These must be communicated and agreed upon with clients during the initial contact and revisited as change dictates, to preserve an ethical therapeutic relationship. Review Standard III on Confidentiality and Standard V on Roles and Boundaries. Before the therapist was able to return the call to the mother, the manager called the therapist into his office to inform him that the mother had called him directly. She was angry and believed that the therapist was interfering with the appropriate medical care of her daughter. The therapist informed the manager that the client had confided her suspicion that she was pregnant and, not being a medical doctor, the therapist was unable to confirm the pregnancy but believed the teen wanted to keep the baby and was taking the appropriate steps to seek assistance from the counselor and obstetrician. The therapist also explained the client’s fear that the parents would insist that she have an abortion.The manager, upon hearing the details and the clients plan of action, realized that the therapist had not interfered with the client’s care but was concerned about whether or not the therapist was obligated to communicate the daughter’s condition to the mother. Analysis This presents a number of potential conflicts in terms of client care, treating minors, obligation to parents, and the difference in perspectives of the client, parent, therapist and manager. This case points to the difficulty the therapist faces
Switching roles, or dual roles, in the therapeutic relationship can lead to confusion and the possibility of transference or counter transference, and both parties are often tempted to continue developing a personal relationship rather than maintaining a professional atmosphere (Riedell, 2005). If this occurs, it could result in emotional harm to the client and at best would interfere with objectivity and the focus on effective therapy to attain client healthcare goals. In this case study the therapist must determine why the client entered the group to be sure that their motivation was not just to be closer to the therapist. The therapist would also have to consider how their disclosure of personal information in front of the client might affect the therapeutic relationship. Would the disclosures in the group impact the respect of the client, would it lead to empathy, sympathy, of pity that might enhance or hurt the therapeutic relationship and under mind the confidence of the client in the therapist’s professional ability. Again the words, “do no harm,” must always be considered when determining the course of action with clients both in and out of the treatment setting. Massage therapists are not prohibited from all social contact in the code of ethics so they must make decisions based on self-assessment and the retention of clear boundaries to be sure all activities are legal and ethical. It is up to the therapist to evaluate the potential risks involved in fostering a dual relationship. When evaluating the risks, consider the following: ● What is the nature of the activity? ● Who initiated the activity? ● Is the activity beneficial to the client? ● What is the level of intimacy? ● Is there a potential for boundary crossing? ● What is the potential impact of the power differential? ● Who is accountable for what in the relationship? ● What is the relative maturity level? ● What are the consequences of participation and non- participation? ● What are the risks to the client, therapist, practice or profession? ● Would both parties be comfortable with public knowledge of the relationship? ● Does it best serve the client or the therapist? (Riedell, 2005) Case study 8 The therapist had been working with a seventeen girl for a year following a car accident that caused a back injury. The teen felt comfortable with the therapist and they had built a trusting therapeutic relationship. During a visit she confided to the therapist that she was pregnant and begged the therapist not to tell her parents because they would try to force her to have an abortion. During the session, the mother called but the therapist was working with the client at the time. The therapist asked the teen how she would like her to respond to the mother’s call since it would have to be addressed that day. The client was aware that her mother knew something was wrong and recognized and that the therapist must return the call to the mother. The client promised to confide in her school counselor and to arrange to visit an obstetrician to confirm the pregnancy and start receiving prenatal care. The client hinted to the therapist that she would like the therapist to be with her when she confronted the mother. The therapist did not respond to the client’s hint.
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Book Code: MTX1225
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