Ethics: Corey Chapter 7

Bartering
Refers to exchanging professional therapeutic services for goods or services in lieu of money.
Boundary crossing
A departure from commonly accepted practices that could potentially benefit clients.
Boundary violation
A serious breach of professional treatment that results in harm to clients.
Dual relationships
Occurs when professionals assume two or more roles at the same time or sequentially with a client; any relationship that is outside the boundaries of the standard therapeutic relationship.
Multiple relationships
Professional relationships characterized by a professional occupying several different nonprofessional roles with a client.
Role blending
Activities that pertain to professionals playing multiple roles and having multiple responsibilities. [Example: Supervisors blend the roles of teacher, coach, evaluator, counselor, and mentor at times].
Slippery slope phenomenon
The argument for carefully monitoring therapeutic boundaries based on the premise that certain actions will inevitably lead to a progressive deterioration of ethical and professional behavior.
ACA Ethical Standard A.5.b
Counselors cannot counsel previous sexual or romantic partners.
ACA Ethical Standard A.5.e
Counselors cannot have person virtual relationship with current clients.
APA Ethical Standard 3.05
Defines MULTIPLE RELATIONSHIP as having professional role with a person and
1) at the same time another role with the client
2) at the same time a relationship with a person closely related to the client
3) promises to have another relationship in the future with the client, or a person closely related tot the client.
– Psychologist refrains from such relationships if it could reasonably be foreseen to harm therapy.
How can ROLE BLENDING be managed?
– Vigilance on part of the professional to ensure that exploitation does not occur.
How can boundaries be managed?
1) Set healthy boundaries from the outset
2) Obtain informed consent
3) Discuss potential risks and benefits
4) Consultation to resolve dilemmas
5) Supervision when needed
6) Document
7) Examine personal motives
8) Refer, if necessary
Gottlieb (1993)
– Decision making model to avoid exploitative dual relationships
– Considers 3 domains:
1) Power differential
2) Duration of relationship
3) Specificity of termination
How does a therapist avoid slippery slope?
– Have a therapeutic rationale for every boundary crossing.
– Question behaviors that are inconsistent with your theoretical approach.
What did Kenneth Pope (1991) say about slippery slope?
Conservative ethicists say that those who push nonsexual boundaries are more likely to become sexually active with clients.
What did Arnold Lazarus (2002) say about slippery slope?
Liberal ethicists say that nonsexual boundary crossings do not necessarily lead to sexual boundary violations.
What did Doverspike (2008) say about slippery slope?
Moderate ethicists say that nonsexual boundary crossings may lead to nonsexual boundary violations.
Hybrid Relationships
Relationships that are partly professional and party social.
When do boundary crossings occur?
1) Incidental encounters
2) Stealth Dilemmas
3) Hybrid relationships
4) Ethical blind spots
5) Role blending
6) Role reversal
What is the best way to stay off of the slippery slope?
Identify your ethical blind spots, by increasing self-awareness through consultation, supervision, and psychotherapy.
How do we have ethical blind spots?
– Ignorance
– Lack of knowledge
– Lack of experience
– denial
– narcissism
– countertransference
Gibson & Pope 1993 survey
92% said using self-disclosure is ethical asa counseling technique
Neukreg & Milliken 2011 survey
86.8% said self-disclosure is ethical
Self-disclosure Decision Making Questions (Doverspike 2008)
1) Is the contemplated action prohibited by an institutional policy?
2) Is the contemplated action consistent with your theoretical orientation?
3) Is the contemplated action part of your treatment plan?
4) How well are you managing clear boundaries and therapeutic neutrality?
5) Where does the disclosure fit on the continuum of privacy/publicity?
6) Is there any foreseeable likelihood that the action could harm the client?
7) How well can you defend your action to your professional peers?
8) Is the action to be made solely for the benefit of the client?
9) How intact are the client’s ego boundaries?
10) What is in the client’s best interests?
Bartering Ethical Guidelines
1) Only at client request
2) Only if non-exploitative
3) Only if not clinically contraindicated
4) Clear written contract established
5) Accepted practice in local community
ACA Ethical Standard A.10.f
When considering accepting gift, take into account:
– therapeutic relationship
– monetary value
– client’s motivation
– counselor’s motivation for wanting to accept or decline
Questions to consider when making decision about accepting gift from client, or attending special event:
1) institutional policy?
2) monetary value?
3) symbolic value?
4) clinical significance of offering?
5) clinical implication of accepting or rejecting?
6) cultural significance of offering?
7) cultural implications of accepting or rejecting?
8) Timing in therapy process?
9) How well are you managing boundaries?
10) your motivations for accepting or rejecting?
11) client’s best interest?
ACA Ethical Standard A.6.b
When considering extending boundaries counselors take appropriate professional precautions:
– Informed consent
– consultation
– supervision
– documentation
2 categories of dual relationships
Publicity (public v. private)
Formality (formal v. informal)
Factorial matrix
What are 4 potential problems with social relationships with clients?
1) Loss of effectiveness
2) Loss of objectivity
3) Risk of exploitation
4) Risk of harm
Pope & Sonne (1993) Survey
Common reactions to sexual feelings in therapy:
– surprise, startle, shock
– guilt
– Anxiety, unresolved personal problems
– Fear of losing control
– Fear of being criticized
Jackson & Nuttall (2001) Dealing with Sexual Attraction
– Therapist, know thyself
– Acknowledge the feelings to yourself
– Explore reasons for attraction
– Be careful about actions being misinterpreted
– Never act on feelings
– Monitor boundaries by setting clear limits
– Seek consultation
– Seek personal counseling
– Terminate and refer if unable to resolve feelings
OCGA 16-6-5.1
1) Sex assault against people in custody, people detained in hospital, or by therapist against patient.
2) Sexual assault = sexual contact with client, or using therapy to facilitate sexual contact
3) Client consent is not a defense
4) Conviction = 1-3 years in prison
Lamb, Catanzaro, Moorman (2003) article
3.5% psychologists at least 1 sexual boundary violation
50% occurred after therapy
Olarte (1997) most common sexual relationship in therapy? Percentage?
88% of boundary violations between MALE therapist and FEMALE clients.
Sexual boundary violator characteristics (Olarte 1997)
– Middle-aged man
– personal distress
– isolated professionally
– overvalues healing abilities
– unorthodox methods
– inappropriately discloses info
Doverpike on relationships with former clients.
“Once a patient always a patient”.