Module 5

Question 1

What are dual relationships?

Answer 1

• Dual/multiple relationships; engaging in another significant meaningful relationship with client in addition to client/therapist
  
  • Either simulatenously or after ending sessions
  • Not Incidental/accidental contact or Boundary crossing
• Three tips for avoidance;
  
  1. Be aware of client vulnerability
  2. In cases of potential conflict of interest, negotiate plan to minimise before commencement
  3. Ensure objectivity is not compromised

Question 2

What is the difference between boundary crossing and boundary violations?

Answer 2

• Boundary crossing; Benign, constructive interactions with client that cross traditional boundaries of relationship
  
  • ​Examples of boundaries; physical contact, self-disclosure, gifts, services, session time
  • Not always problematic but can be a precurser to later transgressions
• Boundary Violations: Major transgressions which disadvantage the client
  
  • ​ eg a sexual relationship

Question 3

What four strategies of ethics acculturation are outlined by Gottlieb and Younggren?

Answer 3

• Two variables in acculturation process
  
  • Maintenance: how much students retain personal ethics and values
  • Contact and Participation: degree of adoption of professional ethics
• Integration Strategy: high on both - incorporate both professional ethics and personal morals
  
  • Least likely to fall for slippery slope
• Separation: high maintence low contact;
  
  • ​More likely to take first step, not slide though
• Assimilation; low maintenance high contact - losing personal values
  
  • Risk of over simplification, distress if rigidity broken
• Marginalisation: Low on both
  
  • ​Most risk of slipery slope

Question 4

What 8 recommendations are made by Gottlieb and Younggren to avoid a slippery slope?

Answer 4

1. Establish a comprehensive informed consent
2. Peer consultation groups (promote integration strategy and reduce cognitive errors)
3. If an issue is identified, document a consultant’s suggestions.
4. Develop and document your own practice ethics policies for consistency
5. Expand on psychotherapist factors included into EDMMs
6. Include understanding of interaction of multicultural context and expected professional boundaries in competence
7. Use positive ethics rather than anxiety based ethics
8. Practice self care

Question 5

What is the 9-step framework suggested by Pope and Keith Speigel for evaluating boundary crossing?

Answer 5

1. Imagine the best and worst possible outcomes
2. Consider research on this boundary crossing
3. Be familiar with codes, guidelines etc
4. Identify a colleague you can trust for feedback
5. Pay attention to any uneasy feelings or doubts and their origin
6. Be stringent in informed consent
7. Refer client onward if you feel compromised or incompetent
8. Do not overlook informed consent process for any planned boundary crossing
9. Keep careful notes.

Question 6

What 7 common errors are outlined by Pope and Keith-Speigel in boundary crossing?

Answer 6

1. What happens outside the session doesn’t impact therapy
2. An action with a therapy client has the same meaning as the action for a non-client
   
   • Out-of-context fallacy; client culture, context, etc all affect the meaning of an action
3. The client has the same understanding of the action that you do
4. Boundary crossing that helped one client will help another client in the same way
5. A boundary crossing is a static isolated event
6. If you can’t see any issues with an action, there aren’t any
7. Self-disclosure is always therapeutic

Question 7

According to Sonne (2005) what therapist factors need to be considered regarding boundary crossing?

Answer 7

• Ethical sensitivity; level of training and recognition of ethical issues
• Willingness to expend effort; avoid making decisions based on simplicity, effort leads to recognition and action on ethical dilemmas
• Guiding ethical principles; Is greater sway given to non-maleficence or client autonomy?
• Gender; Women are more risk averse than men
• Culture/religion; can affect normal levels of personal space/touching
• Profession; Psychiatrist, social worker, psychologist
• Theoretical orientation; psychodynamic therapists more critical of finanical/social connections
• Years as a therapist; tend to be more forgiving of MRs with time, although no more likely to engage

Question 8

According to Sonne (2005) what client factors need to be considered regarding boundary crossing?

Answer 8

• Traits, background;
• Gender; eg men might be encouraged to relate through sport
• Culture/Religion; cultural clashes can lead to percieved boundary crosses. Shared religion can lead to social contact.
• Strengths and vulnerabilities; clients social network strenght, ability to observe and understand boundaries. Eg BPD NPD
• History of prior boundary violantions (abuse)

Question 9

According to Sonne (2005) what therapeutic relationship factors need to be considered regarding boundary crossing?

Answer 9

• Nature of Therapeutic Relationship;
  
  • Level of client clarity over the relationship informed consent
  • Level of client emotional response to therapist
• ​Power differential;
• Duration of therapeutic relationship
• Practice setting; Private practice psychs rate financial MR as significantly less ethical vs community outreach psychs
• Location; small town practitioners more tolerant of non-sexual multiple relationships

Question 10

According to Sonne (2005) what other relationship factors need to be considered regarding boundary crossing?

Answer 10

• Clarity of change; level of informed consent and understanding of any changes to avoid confusion
• Motivation for change; who’s needs are being met?
• Professionals response; Need to account for non-rational factors which may be influencing decision
• Potential for role conflice; Will the roles actively conflict with each other
• Potential for harm and benefit;
• Setting for other relationship

Question 11

What strategies does Dr White suggest to manage unavoidable multiple relationships?

Answer 11

• Set clear boundaries
• Obtain informed consent of the client
• Seek consultation/supervision to aid objectivity
• Document and monitor your practices
• Ask yourself if the potential benefit outweights potential harm
• Self Monitoring is critical
  
  • Be sure to meet client needs not yours

Question 12

What 9 steps do Pope and Keith-Spiegel recommend when problems arise from boundary crossing?

Answer 12

1. Continue to monitor the situation carefully
2. Be open and non-defensive
3. Talk over the situation with an experienced colleague
4. Listen carefully to the client
5. Try to see things from the clients point of view
6. If there is a formal complaint, follow recommended actions
7. Keep adequate, honest, and accurate records of the situation
8. Consider apologising
   
   • Be clear, direct, personal and sincere
   • A partial, qualified non apology is worse than nothing

Question 13

What five types of multiple relationship are identified by Hammond?

Answer 13

• Circumstantial relationships; Coincidential, likely to occur in small communities.
• Structured MRs; when psych and client have more than one role
  
  • eg uni lecturer, researcher, supervisor
• Shifts in professional role; Can occur when psych moves to senior position
• Personal and Professional role conflict; when personal relationships are followed by professional ones or vice versa
• Predatory relationships; taking advantage of the client eg sexual