Three Brief Scenarios and Boundaries
List three brief scenarios that will illustrate examples of the types of boundary issues or multiple relationships you may encounter in the work you will be doing as a counselor. Be specific in describing the client, the counseling setting, and the situation that has raised these issues. Discuss specifically what makes these scenarios ethical challenges. Boundaries make it possible for the relationship between therapist and client to be professional and safe for the client and set the parameters of the services provided.
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The primary concern in establishing and managing boundaries with each individual client is to the best interest of the client. While it is difficult for clients to negotiate boundaries or recognize the need for boundaries, or be able to defend themselves about boundaries violations may initiate behavior that could constitute a boundary violation. Here are three areas of boundary issues that can present difficulty in maintaining boundaries. These are: 1)Dual and overlapping relationships, 2) giving or receiving gifts, and 3) physical contact. 1) Dual and overlapping relationships:
In this scenario, the client is a 25 yr. Old lady who is having difficulty with her husband. It is going to the fourth session with her when you see its’ going on to 11:30 and you are hungry. You suggest that you finish talking while grabbing a bite to eat in the restaurant just around the corner and bring it back to the office to eat. All goes well, and the next time you see this client she brings in sandwiches for you and her to eat during the counseling session. If I asked her not to bring in the lunch, the client may ask why we broke the rule of stepping over a boundary that was set earlier.
What can we do in this scenario? In Corey, Corey & Callanan (2011) p. 273. “Youngren and Gottleib recommend that practitioners address these question to make sound decisions about multiple relationships. (pp. 256-257). •Is entering into a relationship in addition to the professional one necessary? •Can the multiple relationships potentially cause harm to the client? •Is there a risk that the multiple relationships prove beneficial? •Can I evaluate this matter objectively? In this case, was there a breach in boundary crossing?
Again, in Corey, Corey and Callanan (2011) p. 278. Zur,(2007), “The challenge is to find ways to practice ethically with a responsibility, clinical foundation while protecting clients and therapists from risk. Many professionals now agree that flexible boundaries can be clinically helpful when applied ethically and that boundary crossings need to be evaluated on a case-by-case basis. (Herlihy & Corey,2006b, 2008; Knapp & VanderCreek, 2006; Lazurus & Zur,2002; Moleski & Kiselica, 2005; Schank & Skovholt, 2006; Younggren & Gottlieb,2004;Zur,2007,2008). )Giving or receiving gifts In this scenario, a middle aged man from China is coming to therapy to help him with some grief issues he has been experiencing. The client had previously had extended his last session to 10 minutes after the allotted time because he had arrived late. On his following visit, he offers a small gift of appreciation to the therapist. Mistakenly remembering the APA code of ethics which prohibits accepting any gift from a client, who had recently arrived from China, the refusal of a personal gift is a deep insult.
While the incident did provide the opportunity to explore cultural differences and explore personal feelings between both parties, it did result in a better understanding of the gift giving. The therapist acknowledged their differences and was alerted to the client’s cultural background and traditions. It is a reminder that we must remain aware of our own cultural, beliefs, and how they influence our values, assumptions, perceptions, interpretations and choices. In Corey, Corey, and Callanan (2011) p. 294 “Few professional codes of ethics specifically address the topic of giving or receiving gifts in the therapeutic relationship.
The AAMFT (2001) does have such a guideline: Marriage and family therapist do not give to or receive from clients (a) gifts of substantial value or (b) gifts that impair the integrity or efficacy of the therapeutic relationship. (3. 10) They continue: “The latest version of the ACA ethics code (2005) added a new standard on receiving gifts. Receiving gifts. Counselors understand the challenges or accepting gifts from clients And recognize that in some cultures, small gifts are a token of respect and showing gratitude.
When determining whether or not to accept a gift from clients, counselors take into account: the therapeutic relationship, the monetary value of the gift, a client’s motivation for giving the gift, and the counselor’s motivations for wanting or declining the gift. (A. 10. e. ) The reason this is an ethical challenge is that according to AAMFT Code of Ethics (2005),”a counselor does not receive from clients (a) gifts from clients”. However, in the latest version of ACA codes of ethics (2005),” recognize that in some cultures, small gifts are a token of respect and showing gratitude. Therefore, by accepting the gift from the client from China would not break a code of ethics. Initially, the counselor did insult the client but reconciled later by accepting the gift. 3)Physical Contact The scenario: A client comes into the session crying, and bursts into sobbing and shakes uncontrollably. She is a 32- year- old woman who has just lost her mother from breast cancer. You approach her and give her a hug. The client is feeling lonely and discouraged and you want to console her. Touch has been found throughout its history to be important for health, healthy development, and healing.
The medicinal aspect of touch has been known and used for centuries. Touch triggers a cascade of healing chemical responses including a decrease in stress hormones and an increase in serotonin and dopamine levels. In addition, touch has been shown to increase the immune system’s cytotoxic capacity, thereby helping our body maintain its defenses and decreasing anxiety, depression, hyperactivity, inattention, stress hormones and cortisol levels. Clinically appropriate touch increases the client’s sense of trust, comfort and ease with the therapist.
As a result touch is highly effective in enriching beneficial relationship between client and therapist. The meaning of touch can only be understood within the context of who the client is, the therapeutic relationship, and the setting. There are instances when the use of touch should be avoided for those clients who are highly paranoid, hostile, highly sexualized or who demand touch. Special care must be given to clients who have experienced assault, neglect, rape, molestation, attachment issues, sexual addictions, and intimacy issues.
In this case scenario, the counselor gave the client a hug as a token of condolence and support in her grief. It is believed that the counselor did not break any code of ethics. In Corey, Corey and Callanan (2011) P. 317. ” Zur and Nordmarken (2009) note that touch in therapy is not inherently unethical and that none of the codes of ethics of professional organizations view touch as unethical. They suggest that therapists seek consultation in using touch in complex and sensitive cases. “ References: American Association for Marriage and Family Therapist. 2001). AAMFT code of ethics, DC, Alexandria, VA: Author. American Counseling Association, (2005). Code of ethics and standards of practice. Alexandria, VA: Author. American Psychological Association (APA). (2002). Ethical Principles of Psychologists and Code of conduct. American Psychologist, 57, 1060-1073. Aposhyan, S. (2004). Body-Mind Psychotherapy: Principles, Techniques, and Practical Applications. New York: W. W. Norton. Brodsky, A. M. (1983). Sex between therapists and patients: Ethical gray areas. Psychotherapy in Private Practice, 3(1), 57-62.
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