Managing Boundaries and Multiple Relationships - Research Paper Example

Managing Boundaries and Multiple Relationships Introduction Psychology, just like other professions is not exempt from ethical concerns arising from relationships between service providers and recipients. The moral problems in psychology usually arise when therapists or counselors fail to keep their professional relationships distinctive. As a result, these psychology practitioners end up blending their professional association with other forms of relations. These relationships are referred to as either twofold or multiple function associations, since they arise when a psychology professional takes on two or more functions simultaneously or in succession, with a client or another person with a significant connection with the patient. This steady violation of professional boundaries is capable of leading to highly problematical relationships, which end up causing hurt to clients. According to Corey, Corey & Callana (2007), this slippery slope incident is one of the most significant justifications for careful supervision of professional boundaries during therapy. This argument is founded on the notion that specific actions pave way for continuous weakening of principled psychology practice. This paper provides insight into management of multiple relationships in the field of psychology, by examining factors likely to lead to boundary violation and possible mitigation measures including adherence to the ethics code of practice. Although not all dual or multiple relationships result in boundary crossing or violation, therapists must adhere to codes of practice and legislation governing psychology, in order to avoid harming clients or destroying their careers. Boundaries in Therapy Knapp & Slattery (2004) state that boundaries recognized in psychology, particularly in the therapy domain, principally define the fiduciary relationship that exists between a therapist and a client. These boundaries establish what is occasionally referred to as a ‘therapeutic frame.’ The boundaries clearly make a distinction between the psychotherapy relationship and other associations including familial, social, business and sexual, among many others. Some of these limits directly relate to the psychotherapy relationship and may include basic aspects of duration and location of sessions, privacy or confidentially and charges for sessions. The authors further indicate that, there are other bounds that exist between psychiatrists and their clients, instead of around them. These boundaries govern self-disclosure by therapists, the degree of physical contact, language use, dress code, contact between the two parties beyond the sessions, provision or receiving of gifts and the allowed level of closeness during therapy sessions. Boundary Violations and Boundary Crossings Lazarus & Zur, (2002) define crossing or violation of a boundary as any form of deviation from customary modes of therapy, which are characterized by stringent protocols and extensive emotional distance. Boundary violations usually take place in situations where therapists overlook professional decency and end up exploiting their clients. In contrast, boundary crossing usually involves adoption of potentially effective interventions like home visits, self-disclosure, non-sexual physical contact, and exchanging or receiving gifts. Dual or Multiple Role Relationships Gutheil & Brodsky (2008) emphasize that described boundary violations or crossings, usually arise when therapists engage in multiple associations. The authors also indicate that, the American Psychological Association (APA) ethics code provides an in depth meaning of multiple role associations. According to this code, these relationships take place when a practitioner in psychology has a prevailing professional purpose with an individual, but also plays another role with this person. Alternatively, the therapist could engage closely with a person who has a close relationship with the client. Finally, a dual or multiple role association can occur when therapists make a promise about entering into another prospective association with their clients or people close to them. Gutheil & Brodsky (2008) continue examining dual and multiple function relationships, stating that they could occur through actual actions, for instance in a case where a therapist hires a former client as an assistant. The relationships can also be in form of a future proposal in the course of therapy, where the therapist and client make plans about starting a business together or have an intimate relationship once therapy is over. This completely alters the nature of the continuing professional association. However, it is imperative to note that non-sexual role associations with former clients, after termination of therapy are not prohibited by specific provisions within the APA code of ethics. Nonetheless, the code and conventional psychology guidelines advise carefulness even following the natural completion of the professional therapist-client association. This is because specific forms of complicated interactions between therapists and their former clients can be harmful, yet a therapist’s responsibility to clients does not have to end with termination of therapy. According to Lazarus & Zur (2002), multiple or dual functions can be categorized into either contemplated or unforeseeable. Contemplated (or foreseeable) multiple functions are those, which a therapist has opportunity and time to think and evaluate before getting involved. An excellent example of this type of role would be, thinking about whether to admit or turn down a potential psychotherapy client with whom he or she has had a business or social association in the past. Contrarily, unforeseeable functions are those which a therapist cannot reasonably predict. An example of an unpredictable role could be a therapist enrolling in a gym, only to find out later that a fitness instructor at the facility is his or her former client. One of the principal hardships associated with multiple role relationships is that an issue in one association can bring about difficulties in the other. Even though there are documented cases of therapists marrying their former clients, the present moral provisions, like ethical principles under the APA code, usually require a long period of time to pass before making such a move. Boundary Issues Judging from the discussion thus far, it is apparent that boundary issues take place in situations where therapists or other psychology workers establish multiple relationships with current or former clients, whether business, social or professional. However, it is important to note that not every dual or multiple role association is considered to be unethical. For instance, many psychology professionals have unavoidable or unanticipated contact with their present or former clients in shopping malls, during sporting or entertainment events, or even in libraries (Farber, Berano & Capobianco, 2004). Customarily, these meetings are short and rarely pose any noteworthy moral challenge. Gottlieb (1993) indicates that some boundary issues raise vital and disturbing moral questions. Some of the greatest boundary issues involve some form of client exploitation. An example of this is when a psychology professional develops an intimate relationship with the client, with the knowledge that he or she could be psychologically unstable. This is a direct violation of the APA code of ethics since it not only violates the client’s well being, but also shows that the therapist is not acting in the best interest of the psychotherapy client. The author goes on to indicate that other boundary issues could entail more subtle circumstances. For instance, the degree to which a therapist may share private information with a client remains a difficult issue to define. While others argue that self-disclosure could show the client that the therapist completely identifies with their situation, others opine that excessive sharing would be detrimental to the clients’ recovery progress. The other contentious boundary issue is that of social interaction between a therapist and client, especially if they meet coincidentally in social settings. Gutheil & Brodsky (2008) recognize that therapists have been conscious about the discussed boundary issues for a long period of time. However, there is limited research on how to address the issues, especially the subtle ones, in scholarly and profession literature. Most of the literature on dual or multiple relationship problems addresses the issue of sexual or inappropriate interaction of therapists with their clients. As stipulated in the APA (2002), there are legal implications that are related to dual or multiple relationships and they usually depend on the relationship’s nature, as well as, proof that the client is harmed by the association. Any occurrence of a multiple relationship may not constitute of malpractice but only occurs when a therapist abuses his power to harm or exploit a client. Some of the problems are discussed herein. Intimate contact As stated in the APA code (2002), most boundary violations in therapy usually involve some form of intimacy, which is escalated by engaging in sexual intimacy. There are also boundary crossings that take place when therapists adopt potentially effective interventions, but the client perceives them wrongly. For instance, hugging a client can be interpreted as a way of saying goodbye. However, a long and extended hug can be interpreted wrongly, especially if the client suffers from intimacy issues. Additionally, therapists may feel the need to send personal notes to their clients or receive any form of gift. These issues constitute inappropriate gestures and consequent crossing of professional boundaries. Personal gain According to Corey et al. (2007), therapists infrequently get involved in multiple relationships that can lead to some sort personal benefit. For instance, it can be monetary gain from any business deal. It is evident from past cases and experiences that therapists have been enticed to invest money in some of their client’s thriving business. Koocher & Keith-Spiegel (2010) provide an example involving a psychotherapist named Alan Groupie. The said therapist ventured into business with a client suffering from acute depression. He became the movie star’s manager and he even took the initiative to monitor all his business and personal activities, while still charging him the usual therapy fee. The arrangement lasted for a year until the star’s lawyer intervened, filing extortion charges against the therapist. Sometimes these business deals are usually taken to be a form of appreciation by the client to the therapist. Nevertheless, this is wrong because therapists are not supposed to engage in any form of business with their clients, where they benefit financially. Dependency and Emotional issues There are a number of boundary problems that occur from personal issues in counseling. Such issues usually stem from their past experiences like health, legal, financial, career and mostly childhood experiences, Such issues can change or impair the therapist’s judgment, leading to improper multiple relationships, as well as, boundary violations (Farber, Berano & Capobianco, 2004). Altruistic instincts According to Barnett (2011), most of the boundary problems occur because of therapist’s genuine humane inclination. Majority of the therapists are caring, principled and dedicated and sometimes people can take advantage of these characteristics. Some therapists who are extraordinarily benevolent and kind might unwittingly foster multiple relationships. For instance, when a therapist attends a clients’ event, this might give a client the wrong sign. The therapist may also offer the client his personal telephone number in case there is an emergency. Some of these gestures can confuse the client. All the above boundary issues can be solved or mitigated by following ethical codes, setting legal standards as well as mitigation strategies described further in the subsequent section. Ethical codes, legal standards and other mitigation strategies There are ethical codes and legal standards that are set in order to control the intrinsic power of patient-therapist relationship. They set limits for therapist's expression of authority. Additionally, they assist in setting appropriate structures for these relationships, by providing predictable, consistent and reliable framework for this process (Behnke, 2006). Koocher & Keith-Spiegel (2010), indicate that consciousness instilled by ethical codes such as the APA code and legal provisions, reminds therapists to think critically on ethical issues, when making any decisions regarding their relationships with clients. These standards and codes inform, instead of determining therapists’ ethical decisions. Therefore, they have no capability to control feelings and they also don’t protect people from any uncertainties or ethical struggles. This means it is up to the therapists to control their feelings and adhere to their professional code of practice, in order to avoid indulging in dual or multiple relationships. Bennett et al. (2007) supports the assertions by Koocher & Keith-Spiegel in the preceding paragraph, by emphasizing that the code of ethics usually warns therapists of potential issues that can occur in multiple relationships. The code cautions professionals against getting involved with their clients since this might weaken their judgment capacity. Additionally, it may affect their service rendering them inefficient or cause harm to their clients. The therapist is supposed to know that any form of interaction taking place outside the therapy room must adhere to therapeutic objectives. This is an aspect that must be clearly conveyed to all parties prior to engaging in the activity. However, many people usually have an issue when distinguishing where boundaries should be set. This is why the code of conduct must be followed strictly, as a way of propelling interaction toward the right kind of professional relationships. Therapists should make sure that they discuss the issues caused by a dual or multiple relationships with their clients. This way, the client recognizes the necessity of boundaries in the relationship with the therapist. If a therapist gets involved with their clients, they should also seek counseling to assist them overcome such issues. Additionally, reasonable steps should be taken in order to resolve the issue in compliance with the code of ethics (Corey et al., 2007). Conclusion It is imperative to remind people that not all multiple relationships are considered to be unethical. Some of these relationships might be beneficial to the client but it is very important to maintain professionalism. The principal challenge facing numerous therapists is poor judgment of their association with clients. It is extremely crucial for helping professionals to learn how to distinguish dual or multiple relationships from normal therapeutic interactions. This can only be achieved by ensuring that ethical standards are followed to the letter. As a therapist, one should be able to follow ethical guidelines in order to avoid harmful dual relationships. A therapist should be able to act in a professional manner to ensure that the client is well taken care of. This means that if a therapist has to indulge in a dual relationship in order to help a client then he or she should do so within the boundaries of professionalism. One must also remember that such relationships must comply with provisions in the code of ethics and should be considered as therapy. It is also appropriate to keep all records of such interventions, to provide sufficient proof that the interaction was meant to help the client. References American Psychological Association (APA). (1992). Ethical principles of psychologists and code of conduct. American Psychologist, 47, 1597-1611. American Psychological Association (APA). (2002). Ethical Principles of Psychologists and Code of Conduct. American Psychologist, 57(12), 1060-1073. Barnett, J. (2011). Psychotherapist self-disclosure: Ethical and clinical considerations. Psychotherapy, 48, 315-321. Behnke, S. (2006). The discipline of ethics and the prohibition against becoming sexually involved with patients. Monitor on Psychology, 6. Bennett, B., et al. (2007). Assessing and Managing Risk in Psychological Practice: An Individualized Approach. Rockville, MD: American Psychological Association Insurance Trust. Corey, G., Corey, M., & Callana, P. (2007). Issues and Ethics in the Helping Profession. Belmont, CA: Brooks/Cole, Cengage Learning. Farber, A., Berano, K., & Capobianco, J. (2004). Clients' Perceptions of the Process and Consequences of Self-Disclosure in Psychotherapy. Journal of Counseling Psychology, 51, 340-346. Gottlieb, M. (1993). Avoiding exploitive dual relationships: A decision-making model. Psychotherapy, 30, 41-48. Gutheil, T. G., & Brodsky, A. (2008). Preventing boundary violations in clinical practice. New York, NY: Guilford Press. Knapp, S. & Slattery, J. M. (2004). Professional boundaries in nontraditional settings. Professional Psychology, 35, 553-558. Koocher, G & Keith-Spiegel, P. (2010). Boundary Crossings and the Ethics of Multiple Role Relationships. Retrieved from http://www.continuingedcourses.net/active/courses/course066.php Lazarus, A. & Zur, O. (2002). Dual relationships and psychotherapy. New York, NY: Springer Publishing Company. Read More