Importance of Boundaries and Ethics in Therapeutic Relationship - Essay Example

Importance of Boundaries and Ethics in Therapeutic Relationship   Importance of Boundaries and Ethics in Therapeutic Relationship Introduction It is common for most people to misinterpret the therapeutic relationship between a client and a therapist. This relationship can sometimes become confused hence drifting into friendship realms. Given that a disabled client may need frequent assistance from his supportive therapist, it is surprising that other people may misinterpret this relationship as a friendship. Unaddressed, this misinterpretation may cause many complications and ethical issues for both the therapist and the client. Therefore, all therapists must define for themselves individual boundaries between friendship and therapeutic relationship. The present paper aims at discussing the relationship that therapists and clients develop, differentiates between friendships and therapeutic relationships, and highlights the importance of setting boundaries and ethics in a therapeutic relationship. Discussion of the literature in relations to therapeutic relationship Client-Therapist relationship There is a need for counselors to watch the relationship they create with their clients. Setting up boundaries and ethics in therapeutic relations is highly important since it enables the counselors avoid some challenges and complications such as favoritism, ineffective counseling, mental harm, exploitation, and many others. One of the controversial behaviors that a therapist should not involve him or herself is a dual relationship (Lanning, 2007). This relationship occurs when a therapist and client develop a personal relationship that is beyond professional relationship. Setting up boundaries, and ethical codes of standards are important since it aids in ensuring that therapists and clients avoid involving themselves in such relationships, which may results to many complications and consequences to both the therapist and the client. In the context of boundaries and ethics in a therapeutic relationship, most of the literature emphasizes the importance of boundaries and ethics between a client and therapists and the role of such relationship. Although most literatures about the relationships between the client and a therapist mainly focuses on issues of counter-transference and transference, much focus of this paper will be on the real relationships that develop within a long time (Behnke, 2006). Due to the client’s frequent need of the therapist’s assistance and support, it reaches a time when a therapist learns about a client as well as understanding his or her struggles. This results in the development of a strong bond between the therapist and the client whereby the therapist must show total concern and care about the well-being of the client. While trying to help the client address his or her problems such as a disabled person whereby this relationship may last for quite a long time, it is likely that a relationship may develop between the client and the therapist (Lanning, 2007). However, people should not confuse or misinterpret this type of relationship for friendship. It is good to understand that, the therapist is only playing the role of a professional therapist and just trying to meet the goals and objectives of a therapist. Sometimes most clients consider the therapists as their friends. This is a primary cause of confusion with the clients, which stems on the intimate personality due to their disclosure. The clients must share their innermost emotions as well as thoughts with their therapists and this sense of proximity influences most clients to associate themselves with friendship instead of the therapeutic relationship (Behnke, 2006). A disabled client may as well be influenced by such closeness sense due to, for example, social isolation from his or her family or friends and emotions of being lonely. The client’s defenselessness to confuse therapist relationship to friendship may occur due to the therapist attempting to create a rapport between the two. This mainly occurs with new therapists who are concerned with the feelings that the clients like them. Another factor that may compound friendship between a client and a therapist is informal working conditions, especially recreational settings. The last factor that might influence friendship between a client and a therapist is the failure of a therapist to adhere to the rules governing therapeutic boundaries and interactions with clients (Lanning, 2007). This points the importance of boundaries and ethics in therapeutic relationships and that of therapists understanding the limits and boundaries they should set between them and clients in their relationship. Most researchers currently are trying to make a comparison between friendship and therapeutic relationships. Although there is similarity between the two types of relation since there is similar characteristics such as respect, trust, and understanding, there are some differences as well (Lanning, 2007). A therapeutic relationship should be imposed by treatment circumstances, and the interaction between a therapist and a client is controlled by nature and is time limited. A formal therapist-client bond develops in which the therapist must adhere to the therapeutic rules and regulations such as professional, ethical codes and conduct standards (Behnke, 2006). On the other hand, friendship refers to informal and voluntary bond that exists between two individuals who wish to spend most of their time together. Unlike therapeutic relationship, friendship basis of equality and lasts for a long time since the participants enjoy the interaction because of its mutual rewards. Additionally, friendships are always sociable in nature. However, most literatures recognize the inherent challenges that therapists face when trying to balance these two relationships. When, for instance a therapist seems to be more involved with his or her client, the difference between friendship and therapeutic relationship becomes cloudier. Failure to recognize these distinctions and setting boundary limits, both the therapist and the disabled client may find themselves at risk of complications that might negatively affect the whole process of therapy (Lanning, 2005). For a mentally or physically challenged client, these consequences include feeling dependence towards the support of the therapist hence causing the disabled client to overlook creating care and supportive relationship with family relatives and peers. The client’s expectations of favor from peers may lead to confusion hence making the client feel betrayed and isolated when his or her expectations ends in vain (Lanning, 2007). On the other hand, complications of the therapist may be stress, which may potentially lead to professional burnout and allegations of misconduct and favoritism. These complications indicate that setting up limits and boundaries between clients and therapists will be highly essential since it assist the participant to avoid and overcome such complications. Boundaries in therapeutic relationships Setting up personal boundaries and ethics has been important in the therapeutic workplace since beyond the professional policies on principles and ethics of therapists’ conduct, the relationship between a therapist and a client is highly controlled by individual’s decision-making and values. For example, although the professional policy state that, it is strictly illegal for a therapist to involve him or herself into a sexual relationship with a client; it seems that there is little concern towards setting limits to other therapeutic conducts such as the amount of self-disclosure of a therapist. Distinctions of views may reflect distinctions of theoretical orientations or reference’s frames (Behnke, 2006). Although are several factors that serve as determinants for therapeutic boundaries, guidelines seem to be the most helpful and essential for the therapists who are struggling with such issues. The set guidelines should be highly flexible to enable them to fit in different working environments, client’s needs, and situations. For instance, a particular client may feel comfortable for a particular activity such taking him or her for a cup of tea. The benefits might include things such as role modeling and creating a rapport. Another patient may not benefit from this type of activity (Lanning, 2005). Therefore, doing such activity for him or her might cause confusion towards the role of the therapist. Boundaries are a vital aspect that ensures effective therapist-client relationship. Boundaries are important since they aid in setting up the relationship structure between a client and a counselor hence providing a reliable framework for the entire process of counseling. The following example indicates the importance of boundaries and ethics in a therapeutic relationship. Jane, a disabled client, had been visiting David, her therapist for counseling for a period of two years. One day her family rushed her to the hospital and admitted for emergency surgery. The following day, her counselor David paid her a visit at the hospital. He found Jane in horrific pains and sat close to her on her bed. The counselor offered her some encouraging words while holding her hand and he later left the hospital after understanding that Jane’s relatives were about to come. Jane was aware that this session was very different from the usual counseling sessions and that David would not repeat it again. However, David’s visit simply meant that he was caring for her client. At his first counseling session after Jane’s discharge, he took some minutes to explain to Jane about the visit to ensure that she understood that this visit was part of a therapeutic relationship. However, some practitioners may not have visited Jane at the hospital claiming that this was beyond therapeutic relationship and thus people would misinterpret their relationship, others argue that such a decision depends on the circumstances of the individual and the therapist-client relationship. The professional behavior in which the counselor conducted himself during and after the visit was highly important since it enabled him to avoid the circumstances that make clients misinterpret therapeutic relationships to friendship hence causing many complications to both the counselor and the client. David was not cavalier towards the hospital visit; instead he carefully thought about his decisions considering the consequences as well as the benefits for the client. David’s behavior was appropriate to that of a professional therapist because he ensured not to make any mistake by thinking that his visit was similar to that of friendship and he even avoided behaving like a friend. Additionally, setting up boundaries and ethical standards is important since it helps in reducing non-professional relationships such as counselors seeking trade relationships with their clients, therapists engaging in sexual relationships with clients, therapist-accepting partners of family relatives of the clients, and other many non-professional behaviors. In accordance with APA, any form of relationship between a client and therapist that may bring complications or harm to both the client and the therapist is illegal and should be strictly forbidden (Lanning, 2008). Therefore, setting up boundaries and ethical standards will highly aid in reducing such non-professional behaviors and relationships in the workplace. Although the current boundaries only prohibits therapist from developing sexual relationships with their clients, it is also important to make illegal other personal relationships that seem unethical. According to ACA (American Counselor’s Association) (2005), therapist-client unethical relationship with the clients, the romantic partners of the clients, former clients, or their relatives, is illegal and need to be avoided. It is only through setting up boundaries and ethical standards that can end these types of illegal relationships except when such relationships potentially benefit the clients. Additionally, such unethical relationships lie in the hands of the therapist and thus strict judgments are essentials when making decisions on such conditions (Lanning, 2005). Therefore, setting up boundaries will highly aid in decreasing the occurrence of such harmful relationships between therapists and clients. Ultimately, there is the need for every psychologist to set such boundaries. For instance, a therapist might make his or her stance that, dual relationships between the client and therapist is illegal. Another therapist might decide that all therapeutic cases are special and in some situations, dual relationship will be the most appropriate approach without unethical intentions. No matter what stance a therapist may take, it is important for a therapist to decide it prior in order to enable him or the client avoid the jeopardy of coming up with decisions, which are dependent on personal wants, desires, or needs (Lanning, 2008). Setting up such boundaries is essential since it enables the therapist to jeopardize the client-therapist relationship. Discussions of clinically relevant treatment issues related to the therapeutic relationship After undertaking an intense evaluation of the literature, it is realistic that clinical practitioners embark on methods that may raise ethical concerns at different times. However, other clinically relevant treatment issues relate to a therapeutic relationship. These issues include medical indications, client preferences, quality of life, and contextual features. The asserted boundaries and ethical practices enable the doctors and nurses to implement professional and healthy approaches towards their patients (Lanning, 2005). Notably, the health counselors that deal with the physically challenged and mentally disabled people of the society face difficulties in the courses of action they should choose in handling them. The society is always in the forefront to ensure that misconducts shown by the medical fraternity towards such patients is brought to a board. Therefore, the health practitioners face internal and external pressures that hinder the desired results whenever treatment exercises are undertaken with the patients (Lanning, 2008). The literature indicates that medical practitioners show concern towards the process of medication in accordance to the patients’ needs and with reference to the medical industry’s code of conduct. Other ethical issues relate to dual relationship issue, which include, power relationships, self-disclosure, touch, and gifts from either the client of the therapist. There is a need to think about the general attitude concerning the difference between the powers of a client that of a therapist (Zur & whether clients who are CEO, 2010). It obviously understood that the therapist always has more over their clients. Although therapists seem to have powers that are more legitimate over their clients, some clients have more power over their counselor in other forms. Most therapists lose their powers they understand that are sexually attractive to their clients. Another issue related to a therapeutic relationship is self-disclosure. This is one of the important clinical tools and effective predictor of negative or positive therapeutic outcomes. Self-disclosure can be either non-verbal or verbal and accidental or deliberate (Pullen & Mathias, 2010). For instance, although the professional policy state that, it is strictly illegal for a therapist to involve him or herself into a sexual relationship with a client; it seems that there is little concern towards setting limits to other therapeutic conducts such as the amount of self-disclosure of a therapist (Lanning, 2008). Touch is another issue related to clinical treatment issues of therapeutic relationships. Most researches have concluded that touch comprises of several clinical applications. However, at times, touch seems to be highly therapeutically effectual than words. Touch is counseling and psychotherapy mechanism, that therapist must highly put into considerations. Lastly, offering gifts is a traditional and common way that most human beings use to express their gratitude, care, and appreciation. Gifts in counseling and psychotherapy are highly common during holidays, mainly with a romantic partner to client or children to client (Seppa, 2006). Most clients also express their appreciations to their therapists by buying gifts for them. Therapists not only receive gifts from their clients but also engage themselves in therapist-client gift giving (Pullen & Mathias, 2010). On the contrary, therapist gifts have much clinical importance and are most often symbolic gifts such as intermediary objects, greeting cards, or therapeutic-educational gifts such as audio CDs or tapes and psychology books. Offering appropriate gifts between therapist and client is ethical practice and brings benefits to the entire process of therapy. However, rejecting such gifts may cause harm to either the therapist or the client and hence affect the entire process of therapy. The medical fraternity of the society should be considerate of the threats that may result from ill therapeutic approaches and unethical administration of treatment. Physically disabled and mentally challenged individuals often reveal a lack of consciousness in articulating their medical problems to the nurse or doctor tasked to administer medical care to them (Lanning, 2008). Certainly, health workers should consider the appropriate methods to use in examining such patients since verbal and sign language may not provide beneficial information that will serve adequately in resolving the ailments. Because of the vital concerns that evolve from the code’s emphasis to ensuring that the sanctity of life is maintained under all costs, health workers should revert from the use of assumptions in prescribing the medications that are appropriate for such patients (Pullen & Mathias, 2010). The intensive literature indicated that the use of assumptions might expose the patients’ lives into danger, a problem that will translate to unethical administration of treatment. Since the society is always in the lookout to monitor the nurses’ practices, the medical fraternity is exposed to constraints on the process of undertaking their obligations and executing a treatment to their patients as it may spur conflicts. A medical practitioner should precise and brief on the questions that he is willing to expose the physically and mentally disabled patients to during the examination process (Remshardt, 2012). Despite the tedious exercise that the medical practitioner shall face in examining such patients, the boundaries set in ensuring the execution of the code should rest vital hence, the practitioners should not expose the patients into the process of coercion. The asserted boundaries and ethics dictate that the use of coercion in soliciting information from disabled patients or any other groups of patients is heinous and injurious to the rights acquainted to such citizens (Schoener, 2009). The global community’s medical practices seem to match as each constituent society beseeches its health practitioners to consider the sanctity of life in every professional undertaking. The use of coercion and influence in soliciting the required medical results from disabled patients amounts to a break off the code of conduct (Pullen & Mathias, 2010). Therefore, the medical society rests subjected to abide by the ethical code and the social argument concerning the code of conduct. Disabled patients often expose health practitioners into tedious exercises as they try to realize the exact actions to undertake in treating them. It is advisable that the value of life should prevail as the most appropriate method of restraining the occurrence of ill treatment practices is via the use of psychological evaluation tests, a resolution that will enable the workers to accrue the unspoken information (Remshardt, 2012). Despite the vital need to ensure pharmacy-genetic tests in the acquisition of information to aid in the treatment processes, health workers should agree with the patients before administering the tests. Disabled patients are at times incapable of articulating their health problems thus; health practitioners should consider enquiring relevant information from the immediate guardians of the patients. Ideally, the guardians will be capable of rehearsing on the previous and current conditions of the patients to the medical practitioners. In turn, the health practitioners will acquire the relevant knowledge hence they will be capable of implementing precise and accurate pharmacy-genetic tests treatment (Pullen & Mathias, 2010). However, it is vital for the clinical professionals to seek the authorization of the patients’ guardians before undertaking the tests. The behavioral concerns shown by disabled patients are often related to the functionality of certain body organs. Therefore, clinicians, nurses, and doctors should be knowledgeable of the functionalities of the organs before prescribing the tests and medications to administer to such patients since a mistake emanating from unethical practices may risk the health of the patient (Seppa, 2006). The knowledge accrued from the literature concerning the boundaries and ethics practices necessary in undertaking therapeutic analysis on the patients sets a basis on the need to confer with the subjects of medication on their preferences (Remshardt, 2012). Ethical concerns are likely to result whenever the medical practitioners contravene the socially implemented rights and freedoms of every group of patients. After gaining knowledge on the patients’ past histories, medical practitioners should be realistic of the appropriate medication practices to engage on in ensuring protection of their lives and preventing the eruption of conflicts (Schoener, 2009). Any form of illness or injury highly affects the well-being of a client hence leading to a reduction of quality of his or her life. The main objective of all therapists’ counseling is to ensure that they restore and improve their clients’ life quality. Therefore, in clinical treatment situations, the issue of quality of life should highly be put into consideration (Pullen & Mathias, 2010). This topic, which most therapists show no concern, is perilous since it leads to opening of the doo for prejudice as well as bias. Therefore, quality of life must be incorporated when making analysis about the clinical, ethical issues that affect the well-being of the client. Another issue that therapists must consider is the contextual features. Therapist should acknowledge that the clients come to seek their support and counseling mainly because they are facing some challenges that are beyond their control and believe that, only therapists have the appropriate powers to correct such challenges (Schoener, 2009). The previously discussed issues bring out the importance of contextual features. Every treatment, embed in a large context of social and financial arrangements, persons, and institutions; clients’ care is highly influenced either negatively or positively by constraints of such contexts. Similarly, such contexts are affected highly by the decisions that are made about the client, which brings emotional and psychological effects on others (Seppa, 2006). Therefore, it is highly essential to assess and determine the significance of these contextual features. This is because such contextual features are crucially essential towards resolution and understanding of the patient’s case. Summary In the process of therapy, a genuine relationship mainly occurs between a client and therapist. This therapist-client relationship obviously resembles dual relationship and most clients seem to confuse their relationship with the therapist to friendship. However, there are several differences between friendship and therapeutic relationship (Williams, 2008). It is, therefore, the role of all therapists to acknowledge this truth and stand a chance to set up boundaries between therapeutic relationship and friendship. Currently, this concern is mainly for those therapists who highly show concern to this real relationship. This concern increases dramatically if equality develops between the client and his or her counselor due to consumer participation movement. Currently, most therapists tend to cross the boundaries and ethical standards of therapeutic relationships. This is because; most countries only emphasize such boundaries only in offices, which are distant types of therapy. Boundary crossing refers to unethical issues such as gifts, touch, self-disclosure, home visits, and bartering. Dual relationship, which this paper focuses on, is a sub-type of unethical relationships (Zur & whether clients who are CEO, 2010). Dual relationship refers to the existence of numerous connections between a counselor and his or her client. Researches about the replies from different clients conclude that most clients probes for friends and there is the need to come up with solution for these issues. A more concrete approach that can solve such issues is setting up boundaries and ethical standards in therapeutic relationships. Conclusion Efficient therapists usually understand that there are intense emotions that might arise between a therapist and client in the process of therapy. Such feelings can frequently challenge a therapist’s professional and personal boundaries influencing the two involve in unethical and non-professional relationship (Williams, 2008). Therapist who understand the side effects of such non-professional relationships and how the clients can easily misinterpret the therapeutic relationships to friendship should set up boundaries and ethics in their therapeutic relationship. This is because, such non-professional relationships poses many complications and consequences to both the therapists and clients. The most essential thing for counselor to put in mind when involving themselves in the helping fields is that setting professional boundaries and ethics is highly essential for the well-being of both the client and the therapist. The few ethical policies set by governing bodies show fewer efforts in trying to regulate therapists and clients’ actions. In therapy, the clients are of utmost importance; therefore, therapist should understand that their main responsibility is to ensure that they maintain the well-being of the clients. References Behnke, S. (2006). The discipline of ethics and the prohibition against becoming sexually involved with patients. Monitor on Psychology, 37, 86-87. Lanning, W. (2007). Ethical codes and responsible decision-making. Finding your way as a counselor, 111-113. Lanning, W. (2005). Law And Ethics. Lanning, W. (2008). Ethics And Boundary Issues. Pullen Jr, R. L., & Mathias, T. (2010). Fostering therapeutic nurse-patient relationships. Nursing made Incredibly Easy, 8(3), 4. Remshardt, M. A. (2012). Do you know your professional boundaries?. Nursing made Incredibly Easy, 10(1), 5-6. Schoener, G. R. (2009). Exploitation of professional relationships. In First Swiss Congress Against Violence & Abuse of Power. Pre-congress Workshop, Rehabilitation for the professional who has violated boundaries.(21 September). Seppa, N. (2006). Supreme court protects patient-therapist privilege. APA Monitor, 27(8), 39. Williams, M. H. (2008). Boundary violations: Do some contended standards fail to encompass commonplace procedures of humanistic, behavioral, and eclectic psychotherapies. Psychotherapy, 34, 238-249. Zur, O., & whether clients who are CEO, D. (2010). Power in psychotherapy and counseling. Online Publication by the Zur Institute. Read More