1. Boundaries in clinical psychology Flashcards
How is the professional relationship different from other relationships?
- Payment –fiduciary financial relationship
- Absence of physical contact
- Time limits
- Confidentiality
- Don’t give gifts
- Avoidance of multiple relationships
- Asymmetry of self-disclosure
- Specific location
What should be taken into account when accepting a gift?
- How much the gift cost
- Whether the person can afford it
- What it means for the person to give it (e.g., gratitude, or romantic gesture)
- Timing of a gift –if not at Christmas or end of treatment, then not really appropriate; and they should not know your birthday
What should you do if you are given something?
Check policy of the organisation – some hospitals share all gifts between colleagues. Private practice hard –presents are wrapped.
How can the integrity of a psych be compromised by accepting gifts?
If lavish present, then integrity may be compromised; e.g. client pays for holiday, then asks for medical note.
What should a therapist provide?
A safe structure to allow for warmth, empathy and spontaneity.
If you suspect child abuse, what then?
Mandatory reporting of child abuse.
Can children of 14-15 ask for confidentiality?
Grey area. They can ask for confidentiality if deemed competent.
What’s the risk involved in giving patient a lift?
Conversation could get personal –outside of the therapeutic zone.
What’s the danger of disclosing to patients?
This may create intimacy between client and therapist.
How you can ensure clients don’t learn stuff about you?
- Tell your secretary not to give out information.
- If computer is getting repaired, take info off first.
What’s the difference between a boundary crossing and a boundary violation?
Crossing –intended to advance therapy constructively, but may be a departure from accepted practice. Are inevitable in a long-term clinical relationship.
Violation –may be harmful or exploitative. Not in interests of client.
Why is flexibility important?
To accommodate individual differences in patients and clinicians.
What is the gender split in sexual boundary crossings?
Males –1-12%
Females –0-3.1%
What are the four types of clinicians who cross sexual boundaries?
- Psychotic disorder.
- Very rare. - Predatory psychopathy and paraphilia.
- Antisocial or narcissistic PD
- Patients are ‘easy targets’
- Almost always male - Lovesickness
- Infatuated with patient
- Mistakes own needs for patient’s
- Mainly female - Masochistic surrender
- Allows patients to control them
- Unable to set limits
Why is crossing sexual boundaries wrong? Three things
- Abuse of power –therapist is being paid to help with patient’s psychological problems.
- Exploitation –therapist’s needs are placed above patient’s needs
- Failure to provide services contracted to provide.
What are the APS Guidelines for sexual relations with a client?
- Not with client or anyone closely related to client, for two years after termination of therapy.
- If after two years must explore with a senior therapist the possibility that former client may be vulnerable; encourage client to seek independent counselling on the matter.
- Not accept as client former sexual partner.
What are the pros and cons of the two-year rule? 2 of each
CONS
- Permanent ban is an infringement of rights (freedom of association)
- If they get married, exploitation is hard to prove
PROS
- Transference is immediately re-established upon reunion between patient and therapist
- If possibility for sexual/romantic relationship exists, then therapy is contaminated.
Why is supervision useful?
- to monitor boundary violations
- reassure that feeling attraction is not uncommon or shameful
- help recognise harm caused if therapist were to act upon attraction
What are 7 common boundary issues?
- Special fee arrangements (low or free)
- Extending time beyond what was initially agreed
- A small gift. Large gift.
- Self-disclosure
- Socialising with the patient
- Calling each other by first name
- Non-sexual physical contact
Describe the ‘slippery slope’ or ‘road much travelled’ (Simon, 1995)
- The ‘slippery slope’ or the ‘road much travelled’ (from Simon, 1995)
- Therapists’ neutrality is eroded in ‘little’ ways
- Therapist and patient address each other by first names • Therapy sessions become less clinical and more social
- Patient is treated as ‘special’ or confidant
- Therapist self-disclosures occur, usually about current personal problems and sexual fantasies about the patient
- Therapist begins touching patient, progressing to hugs and embraces
- Therapist gains control over patient, usually by manipulating the transference and by negligent prescribing of medication
- Extra-therapeutic contacts occur
- Therapy sessions are rescheduled for the end of the day
- Therapy sessions become extended in time
- Therapist stops billing the patient
- Therapist and patient have drinks/dinner after sessions; dating begins
- Therapist–patient sex begins
What confidentiality issues are there with teenagers?
Grey area for competence. Should discuss with them beforehand whether they give you permission to discuss things with their parents if asked.
In what cases should you document?
- If a patient makes you feel uncomfortable.
- When you consult a superior about something.
- If there has been a boundary crossing from you or patient.
If you are being supervised you should disclose to client that…
You may discuss their case with supervisor, but will not mention identity.
