Counselor Ethical Boundaries and Practices - Pcn 505

“Counselor Ethical Boundaries and Practices”

PCN-505

Matt Hoskins

Boundaries in counseling are important to be kept by the counseling professional.  There are many types of boundaries and relationships that may be formed in the counseling environment.  Boundary crossing is not always unethical but boundary violations are.  This paper will discuss some of the boundary issues and relationships and how they affect the client-counselor relationship.  

Some boundaries might be constructed for the purpose of the counseling relationship.  These can be such things as the time and place which the therapy will occur, professional fees, confidentiality and the like.  Other boundaries are drawn between the therapist and client for the protection of the relationship.  These boundaries would include, “self-disclosure, physical contact (i.e., touch), giving and receiving gifts, contact outside of the normal therapy session, use of language, clothing and proximity of therapist and client during sessions” (Zur, 2014).  

   “Standard 3.05 of the APA ethics code outlines the definition of multiple relationships. Dual or multiple relationships occur when:

• a professional and personal relationship take place simultaneously between the psychologist and the client
• the psychologist has a relationship with a person closely related to or connected to their client
• the psychologist has intentions to enter into a future relationship with the client or someone closely related to the client” (APA, 2014)

Determining if a boundary crossing or dual relationship is ethical and appropriate depends on who you ask.  However there are guidelines to help in determining when the relationship is unethical.  Zur states, “Boundary crossings can be an integral part of well formulated treatment plans or evidence-based treatment plans. Examples are, flying in an airplane with a patient who suffers from a fear of flying, having lunch with an anorexic patient, making a home visit to a bed ridden elderly patient, going for a vigorous walk with a depressed patient, or accompanying a patient to a dreaded but medically essential doctor's appointment to which he or she would not go on their own” (2014).   In rural communities and small towns, dual relationships are, “normal, unavoidable and expected” (Zur, 2014). The crossing of boundaries does not always match the criteria for a dual relationships.  However, any boundary crossing should be done only after a thorough examination of the motivation behind it.  Zur states, “boundary crossings should be implemented according to the client's unique needs and the specific situation”.

        Boundary violations occur when the dual relationship becomes or currently is exploitive in nature.  Younggren states, “Exploitation of patients is unethical and if the proposed dual relationship is exploitive of the patient, then it is unacceptable” (2014).  Issues of physical attraction between the counselor and client present a particularly precarious situation for both the counselor and client.  This is an issue which needs to be dealt with as soon as it is encountered.  Pope, Tabachinick and Spiege state, “The mental health professions, despite the citations mentioned above, seem to shy away from dealing in an honest, open way with the phenomenon of sexual attraction to clients. Yet, it should be, in our opinion, a central issue in the training of psychotherapists” (2012).   There is however a dramatic difference between physical attraction between the client and counselor and the actual sexual relationship.  However many authors suggest that bringing the client’s feelings of attraction into the open can actually be beneficial to the psychotherapeutic process.  As Shwartz states, “sexual attraction, as well as other emotions (anger, disappointment, anxiety and fear) are extremely important to the therapeutic process and needs to be brought out into the open where the process of psychotherapy enables the patient to learn, grow as a person and gain improved functioning in their life” (2008).  The attraction often is a phenomenon known as transference.  “Transference refers to the idea that our reactions to people in the present are shaped by past relationships. In other words, the ways in which we were treated in the past, such as by parents, gets repeated in the present because those are the expectations that we have” (Schwartz, 2008).   The boundary violation occurs when the therapist acts upon the attraction.  This is not the therapist’s place to fulfill the client’s desires.  Rather, it is their duty to assist the client in identifying the underlying issues leading to the desire.  It is important to address this issue so that, as Schwartz states, “the patient can enter into a fulfilling intimate relationship with a partner from the world outside of psychotherapy” (2008).

        In dealing with boundaries as they apply to current and former clients, the lines are often times different.  With regard to current clients, it would be unethical to have them as a Facebook friend.  The reason is that the amount of self-disclosure the patient would be exposed to may hinder the therapeutic relationship.  Walker and Zur state, “As with most other types of boundary crossings and dual relationships, psychotherapists must consider the potential benefits of accepting or not accepting clients' friend requests as well as the potential risks. Psychotherapists should think through whether accepting clients as online friends is reasonably likely to cause harm, exploitation, loss of objectivity, or loss of therapeutic effectiveness. The 2014 ACA Code of Ethics added a new requirement that counselors avoid "personal virtual relationships" with clients. The precise meaning of this is unclear, but would likely include creating "friend" relationships with clients on the clinician's personal social media profile(s)” (2014).  This may not be an issue however with former clients.  This is due to the therapeutic relationship being terminated.