Section 8 Flashcards
On what grounds are psychologists most frequently disciplined?
S8: A
p 541
Boundary violations
Who was responsible for introducting the concept ot role boundaries into professional ethics and why
S8: A
p 541
By: feminist scholars
Why: they were upset at the (mostly sexual) exploitation of (mostly female) clients by (mostly male) professionals
What balance do psychologists try to strike in maintaining health boundaries with clients?
S8: A
p 541
Protecting personal autonomy and facilitating personal engagement
(find professional stance between under involvement and over involvement)
Why are boundaries so important to professional ethics?
S8: A
p 542
Because of the inherent power imbalance in our relationships with our clients
Instead of just avoiding dual relationships, psychologists are advised to avoid _____ dual relationships
S8: A
p 542
Harmful dual relationships
Sometimes dual relationships are unavoidable, e.g. rural communities
Which parts of the Code of Ethics provides guidance on dual relationships?
S8: A
p 543
Principle iii: Integrity in relationships
- do not exploit relationships established as a psychologists for personal, political, business gain
- avoid multiple/dual relationships
Integrity helps us to avoid being lustful, greedy, vain, etc (using relationship for wrong reasons)
Speak to the ethical conflict with allowing a client barter for service (provide something other than the professional fee in payment) (dual relationships)
S8: A
p 544
- can be problematic because you may then become that client’s employer (e.g. if client offers carpentry services in exchange for psychotherapy) –> power imbalance
- can easily lead to feelings of betrayal if either party becomes unhappy with arrangement
Speak to the ethical conflict with giving and receiving gifts (dual relationships)
S8: A
p 544
- may change the role expectations of the professional relationship
You give a gift: client may feel pressured to reciprocare to avoid getting inferior care
Client gives gift: you may feel need to reciprocate by giving “special care”
- be sensitive to cultural nuances here
Speak to the ethical conflicts that may arise in rural practice (dual relationships)
S8: A
p 545
urban psychologists - much less likely to have challenges with dual relationships
rural - turning away clients can result in financial hardship for you and can be harmful to client (limited access to service)
Must weight potential harm of turning client away against potential harm arising out of dual relationship
Recommended: rural psychologists develop generous capacity for tolerating ambiguity in relationships, use good consent forms, and lean towards providing brief/less intense services where appropriate
Speak to the ethical conflicts that may arise in providing forensic services (dual relationships)
S8: A
p 545
The LEGAL system often becomes the client, not the person involves
Occurs when psychologists are asked to provide consultations on child custody cases, parole decisions, etc
Speak to the ethical conflicts that may arise in providing teaching and supervision (dual relationships)
S8: A
p 546
Professors-student relationships can be complex dual relationships, can have risk for exploitation due to power imbalance in relationship (2 - 15 % of students have engaged in sexual relationships with professors, decreasing)
Supervision can be complex with facilitator/supporter role conflicts with evaluative role
What are some of the ways you can deter your client from thinking you are open to a sexual relationship?
S8: A
p 550
- clarify cultural norms around personal space, etc
- do not ask about client’s sexual history unless it is directly relevant to the case
- respond with brief “thank you” to compliments, move on and do not reciprocate
- do not answer questions about your own sexuality
What factors should you consider when deciding if you should or shouldn’t accept a client’s gift?
S8: C
- the monetary value (no no to lavish gifts)
- what the clinical implications might be if accepting/declining
- when in the therapy process were you offered the gift (much more damaging/risky at beginning)
- what are YOUR motivations for acceping/declining gift
- are there relevant cultural implications
When might it be okay to accept a gift from a client?
S8:C
p 563
- small, inexpensive
- culturally appropriate
- at the end of therapy
T or F: Touching clients should generally be avoided
S8: C
p. 565
False: nonerotic touching is often appropriate and can have significant therapeutic value; of course - do with discretion depending on client and nature of relationships
Compare and contrast boundary cross vs boundary violation
S8: E
p. 573
Boundary crossing: departure from common practice that could potentially benefit the client (e.g. pat on shoulder)
Boundary violation: serious breach that results in harm to client; unethical e.g. sex with client
What the the phrase “avoid the slippery slope” mean and why is it important?
S8: E
p. 573
A gradual erosion of boundaries that can lead to problematic multiple relationships that bring harm to clients
–> happens when boundaries are poorly defined and when therapists allow role to blend
Important because one or two sloppy boundaries can lead to progressive deterioration of boundaries, causing harm to client
How does one “avoid the slippery slope”? (2 ways)
S8: E
p. 573
- Have a therapeutic rationale for crossing the boundary
2. Question behaviors that are inconsistent with theoretical approach/code of ethics
What are some questions you could ask yourself if you are having difficulty maintaining appropriate boundaries with your client?
S8: F
p.577
- IS THIS IN THE BEST INTEREST OF MY CLIENT?
- who’s needs are being served
- will this impact my quality of service
- how would the client’s family view this?
- how would a colleague view this?
- am i treating this client differently from other clients?
- does this client mean something ‘special’ to me?
- can I put this in my client’s file
List a few reasons why sexual multiple relationships should be avoided? (impact on client)
S8: H
p.582
Oberlander and Barnett
Abuse of trust
Misuse of power
Harm
Exploitation
What are some of the ‘slipppery slope boundaries’?
(one should be conscious of how they interact with client’s on these factors to avoid ethical violations)
S8: H
p.583
Oberlander and Barnett
role time space touch self-disclosure gifts physical contact
Why are nonsexual multiple relationships acceptable between faculty and students?
S8: H
p.584
Because this allows faculty to serve as guides role models teachers sponsors helps student access opportunities for career and P.D
Describe the Decision Making Model for Graduate Assistants (dual relationships)
S8: H
p.587
- Is the dual relationship NECESSARY
- Is the dual relationships EXPLOITATIVE
- Who does the dual relationships BENEFIT
- Is there RISK that dual relationship could HARM STUDENT
- Could dual relationship DISRUPT EDUCATIONAL relationship
- Is evaluation of dual relationships OBJECTIVE
- Have you DOCUMENTED decision-making process
- Did student give INFORMED CONSENT to risks of dual relationships
What are some strategies you can use to avoid dual relationships with students as a GA/TA/etc?
S8: H
p.590
- Recognize your position of power of students
- Recognize vulnerability of psych students (we’re all a bit nuts)
- Limit social contact with students; keep it professional
- Be aware of continuum of multiple relationships (not all are harmful)
- Be aware of resources of report sexual harassment
- Consult
- Be vigilant of emotional distress such as isolation (in self and others)
- Acknowledge power/responsibility of having a faculty role
- Develop process for evaluating student-faculty relationships
- Foster climate for ethical relationships
Speak to the difficulty/complexity of treating clients who have been sexually abused by a previous therapist
S8: J
p. 599
Treating these clients tends to be exceptionally difficult and complex.
T or F: Psychiatrist engage in more sexual dual relationships with patients than psychologists, social workers
S8: J
p. 600
F - no significant difference between the three
BUT Marriage and Family Counsellors are far more likely to do so
In what ways could the research on the impacts of sexual dual relationships on client be skewed?
S8: J
p. 601
Some say that only those who have been harmed by dual sexual relationship would come forward to participate in research; those who may not have been harmed or who benefited may not come forward to participate in studies
Much we will never know about impact of sexual victimization of clients (difficult to study)
What are some of the symptoms of Therapist-Patient Sex Syndrome?
S8: J
p. 601
ambivalence guilt emptiness/isolation sexual confusion impaired ability to trust identify/boundary confusion emotional lability (undergoing change) pressured rage increased suicidal risk cognitive dysfunction
What are some of the common reactions that therapists may have when they find out their client has been sexually exploited by a therapist?
S8: J
p. 603+
- Denial and disbelief (question credibility of story; protecting profession
- Minimization of harm (based on cultural tendency to minimize victimization of women)
- Making patient fit textbook (not sure p 610)
- Blaming the victim (they had a role in it)
- Sexual reaction to the victim (aroused by victim)
- Resentment/discomfort at lack of privacy (if victim decided to file a complaint)
- Difficulty keeping the secret
- Intrusive advocacy (trying to convince client to report/not report perpetrator)
- Vicarious helplessness (difficulty managing own symptoms of distress)
- Becoming object of rage, neediness and ambivalence (transference for client’s anger/depression)
Describe some of the impacts/belief clients may have about being sexually victimized?
S8: J
p. 610
- remain in long period of shock
- numbing of cognitive/affective reactions
- severe boundary disturbance
- may be convinced that perpetrating therapist could read their mind
- may believe that abuse was legitimate/useful to therapy; that therapist was genuinely caring for them (analogous to battered wive syndrome)
- ambivalence (clinging/worshiping abuser AND fearing/despising abuser)
- may experience deep, chronic, shame
What are the two most commonly held beliefs by perpetrators (therapists) of sexual abuse regarding the dual relationship?
S8: J
p. 610
- The victim was not genuinely harmed
2. The victim was not a vulnerable individual (actually the instigator or at least a willing participant)
How does the therapeutic relationships change if your patient, a victim of therapist-client sexual abuse, decides to file a complaint?
S8: J
p. 613
conversations in therapy continue despite:
- the fact that they may not be confidential
- chart notes could be subpoenaed
- therapist may be deposed/cross examined
- may be blamed for client’s current symptoms due to your ‘incompetence’
What are the three major types of sexually abusive therapists? List some of the subtypes
S8: J
p. 610
- Power and Control
Sexual preoccupation (focused on sex)
Substitution (patient fulfills another role for therapist)
Attraction to pathology (e.g. attracted to narcissism)
Authoritarian orientation (wants power over dependent)
Physical immobilization (attracted to people who can’t move) - Anger
Battering (feels justified in hitting patient)
Emotional abuse (feels justified in screaming at patient)
Provoking Decompensation ( encourages client to perform activities that will harm them e.g. drugs) - Sadism
Pleasure in causing pain to patient
Sexual humiliation
Why should the dual relationships that graduate student experience be given more attention?
Oberlander and Barnett
p. 582
lessons learned during one’s grad school experience about appropriate maintenance of boundaries and how to ethically manage multiple roles/relationships will likely significantly impact one’s future conduct
