Boundary Issues and Dual Relationships in Mental Health Treatment

Understanding the Importance of Empathy and Warmth in Therapy

Task:

Mental Health professionals often work with individuals experiencing a myriad of emotional issues. Clients may seek out the assistance of a therapist to “fix” a problem or give advice on how to deal with the problem. If a professional appears cold or insensitive it can be an uncomfortable situation for a client and cause him or her to turn away from treatment. Empathy and warmth from a therapist may comfort a client and assist with creating a positive rapport. A client who feels safe and supported may even reach out to a professional for physical contact. In this case a therapist may find himself crossing a boundary with a simple touch. Boundary crossings, boundary violations and dual relationships are subjects of great importance when one is considering working in the mental health field. Understanding these subjects can be beneficial for the protection of both the client and the professional.

Section 1: Boundary Issues and Dual Relationships

There are situations when crossing a boundary or entering a dual relationship is considered acceptable and may be part of the therapist’s treatment plan. The 2014 ACA code of ethics recommends that professionals use caution when extending boundaries with a client. One should consider all risks along with the benefits. Documentation is vital when extending boundaries and must be commenced prior to the action. When recording the information, one should include the reason for the interaction along with prospective benefits and projected results. If any harm does transpire, there should be proof that the professional tried to resolve it. Role changes must also be documented, and a new informed consent must be acquired (A.6.).

When determining if a boundary crossing or dual relationship is appropriate Pope and Spiegel (2008) suggest several things to consider. One step is to contemplate the best and the worst outcome from the boundary crossing. One should ask himself if there is a possibility of significant harm. One should look for research and published literature pertaining to the boundary crossing. If there is no research on the subject, the professional may want to discuss it with his or her professional association. Professionals should look for input and guidance from colleagues. A professional should consider how he or she responds to the client. Mental health professionals should be aware of their own actions such as, spending extra time with a client. Other signs of a possible impending issue include dressing differently for a client, sharing to much personal information and giving a client one’s personal phone number (CPT.BC, 2009). Corey, Corey and Callahan (2014) point out three things to contemplate when entering a dual relationship. The professional should ask himself if there is a risk of exploitation of the client, can the personal relationship cause damage to the professional one and will he lose objectivity? While some boundary crossings may be acceptable, boundary violations however, should never even be a consideration. A boundary violation is potentially harmful to or manipulative of the client. Violations can be both sexual and nonsexual.

Examples of Dual Relationships/Boundary Crossings

There are multiple scenarios in which a therapist may need to evaluate the situation. For example; a counselor is asked to teach a few classes at a local community college. While looking out into the classroom he or she finds a client sitting at a desk. The professional should consider if the class subject may include something that could potentially harm the student. The aspects of the class subject along with the counselor teaching the class, should be discussed at the next session. The student/client should sign a new informed consent and discuss how to interact while in class. The client may wish to keep the class from knowing about the professional relationship.

A therapist who is a classic car enthusiast is a member of the local Mustang club. After attending a meeting, he realizes that a client is also a member of the club. Both have friends in the club and enjoy taking their cars to shows. The therapist may feel very connected to the client because they share a group of friends. In this case objectivity could be lost, so the professional will need to continually self-monitor himself. The professional relationship could be damaged if the client and therapist begin to spend additional time together as well. If the client is a mechanic his therapist may exploit him by asking for help working on the car.