Chapter 9: Managing Boundary Issues

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Chapter 9: Managing Boundary Issues

Chapter 9 Lecture Notes

Managing Boundary Issues

CHAPTER OUTLINE

Aim of the Chapter

Self-Inventory on Managing Boundaries

Multiple Relationships and the Codes of Ethics

The Multiple Relationship Controversy

A Cultural Perspective on Boundaries

Multiple Relationships and boundary Issues in Small Communities

Establishing Personal and Professional Boundaries

Guidelines for Setting Boundaries

Combining Personal and Professional Relationships

Factors to Consider in Balancing a Professional and Personal Relationship

The Cultural Context in the Intersection of Personal and Professional

Socializing with Former Clients

Social Media and Boundaries

Bartering in Counseling

Ethical Dimensions of Bartering

Legal Aspects of Bartering

Other Perspectives on Bartering

Giving and Accepting Gifts in the Therapeutic Relationship

Dealing with Sexual Attractions

Training in Managing Attractions

Sexual Relationships with Current Clients

Sexual Relationships with Former Clients

CHAPTER OVERVIEW

· A multiple relationship may occur whenever you interact with a client in more than one capacity. Be aware of your position of power and avoid even the appearance of conflict of interest.

· The codes of ethics of most professional organizations warn of the potential problems of multiple relationships, yet most codes do not prohibit all such relationships.

· Helpers are faced with the challenge of learning how to effectively and ethically manage multiple relationships, including dealing with the power differential that is a basic part of most professional relationships, managing boundary issues, and striving to avoid the misuse of power.

· It helps to keep your relationships with your clients on a professional, rather than a personal, basis. Mixing social relationships with professional relationships often works against the best interests of both the client and the helper.

· Traditional views of boundaries often need to be considered in an expanded light when counselors work in the community and advocate for social justice.

· Helpers who work in rural communities face unique challenges in managing boundaries and multiple relationships. Some multiple relationships cannot be avoided, and helpers must exercise good judgment in establishing ethical boundaries for these relationships.

· Exercise prudence in using social media. Be aware of the problems inherent in friending clients on Facebook. Keep up with the rapid developments in technology that can raise new issues related to professional boundaries.

· It is a good idea to avoid bartering, except when this is the best available option and when it is the cultural norm. Exchanging services can lead to resentment on both your part and your client’s.

· In deciding whether to accept a gift from a client, consider the cultural context, the client’s motivations for offering a gift, and the stage of the helping process.

· Sexual attractions are a normal part of helping relationships. It is important to learn how to recognize these attractions and to develop strategies to deal with them appropriately and effectively.

· Sexual misconduct is one of the leading causes of malpractice actions against mental health providers. Sexual intimacies between helpers and clients are unethical for a number of reasons. One of the main reasons is that they entail an abuse of power and trust and usually cause harm to clients.

KEY CONCEPTS AND TERMS

Bartering refers to exchanging professional therapeutic services for goods or services in lieu of money.

Boundary crossing is a departure from commonly accepted practices that could potentially benefit clients.

Boundary violation is a serious breach of professional treatment that results in harm to clients.

Dual relationships is another term to describe multiple relationships.

Multiple relationships may involve assuming more than one professional role (such as instructor or supervisor and therapist) or blending a professional and a nonprofessional relationship (such as counselor and business partner).

Copyright © 2019 Cengage Learning. All rights reserved.

Copyright © 2019 Cengage Learning. All rights reserved.

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Chapter 8: Ethical and Legal Issues Facing Helpers

Chapter 8: Ethical and Legal Issues Facing Helpers

Chapter 8 Lecture Notes:

Ethical and Legal Issues Facing Helpers

CHAPTER OUTLINE

Aim of the Chapter

Inventory of Ethical Issues

Ethical Decision Making

Law and Ethics

Professional Codes and Ethical Decision Making

Codes of Ethics of the Various Professional Organizations

Recognizing Unethical Behavior in Yourself

Unethical Behavior by Colleagues

An Ethical Decision-Making Model

Informed Consent

Confidentiality and Privacy

Confidentiality in Couples and Family Therapy

Confidentiality in Group Counseling

Confidentiality in School Counseling

Confidentiality and Privacy in a Technological World

Privacy in a Small Community

Your Obligation to Protect

Documentation and Keeping Records

Ethical Issues in a Managed Care Environment

Key Ethical Issues

Legal Aspects of Managed Care

Trends in Managed Care

Malpractice and Risk Management

Grounds for Malpractice Actions

Ways to Prevent Malpractice Suits

Risk Management

A Word of Caution

CHAPTER OVERVIEW

• One of the trends in the helping professions is an increased interest in ethical and professional practice. This trend stems, at least in part, from a rise in malpractice actions against mental health practitioners.

• Ethical decision making is a continuing process. Issues that you look at as a student can be examined from another perspective as you gain experience in your professional specialty.

• It is essential that you be familiar with the professional codes of ethics. However, knowledge of ethical standards is not sufficient in solving ethical problems.

• Becoming an ethical practitioner involves an integration of both personal and professional ethics. Recognize that unethical acts are often subtle and unintended. Maintain a stance of honest self-exploration to ensure ethical behavior.

• Ethical issues rarely have clear-cut answers. Ethical dilemmas, by their very nature, involve the application of professional judgment on your part.

• Routinely utilize a systematic ethical decision-making process such as the eight-step model provided in this chapter or another one that you personally devise. This type of system encourages objectivity, research, analysis, collaboration, and documentation—all of which are important elements in effective and ethical practices.

• Ultimately, you will have to make many difficult decisions as a practitioner. Responsible practice entails basing your actions on informed, sound, and responsible judgment. Be open to consulting with colleagues and supervisors throughout your professional career.

• Many clients have not even thought about their rights or responsibilities. As a helper, you can do much to safeguard your clients by developing informed consent procedures to help them make wise choices.

• Confidentiality is the cornerstone of the helping relationship. Although clients have a right to expect that what they talk about with you in the professional relationship will remain private, there are times when you will have to breach confidentiality. Clients have a right to know from the outset of the relationship the specific grounds for divulging confidences. It is essential that you know and follow the laws pertaining to confidentiality.

• Confidentiality is limited when you work with couples, families, groups, and minors. These limitations should be discussed in your informed consent process.

• At times you will have a professional and legal obligation to warn or to protect clients. It is essential that you know your duties in this area.

• Your job is to teach clients how to help themselves and thus decrease their need to continue seeing you. Encouraging dependency in your clients is unethical, and it does not lead to client empowerment.

• It is essential to keep adequate clinical records for all clients. Documentation is critical, both for the client’s benefit and for the protection of the professional rendering the services.

• If you rely on advanced technologies such as cloud computing for the storage and protection of client data, be aware of the ethical complexities involved.

• Be cognizant of the relevant legal and ethical issues if you communicate with clients via e-mail or online.

• Helpers who work in a managed care setting inform their clients about the services available and about potential limitations on the helping relationship due to the focus on cost-effective methods.

• Take an ethics course or, at the very least, read a book on professional ethics, and attend professional conferences and workshops dealing with ethics and the law.

• Understand what can lead to becoming involved in a malpractice suit, and learn practical ways to lessen the chances of this happening.

KEY CONCEPTS AND TERMS

Abandonment involves the desertion of a client by a helper who has assumed responsibility for being involved in a professional relationship with the client.

Aspirational ethics goes beyond the minimal standards of practice and entails an understanding of the spirit behind the code and the principles on which the code rests.

Competence pertains to a professional helper being able to render effective assessment or treatment in a specific area by virtue of his or her education, training, and supervised experience.

Confidentiality is an ethical concept and, in most states, the legal and professional duty of therapists to not disclose information about a client. Psychotherapists are prohibited from disclosing confidential communications to any third party, unless mandated or permitted by law to do so.

Duty to warn refers to a mental health professional’s responsibility to inform an endangered person when it is believed a client poses a serious danger to an identifiable person.

Ethics represents aspirational goals, or the maximum or ideal standards set by the profession. Ethical standards are enforced largely by professional associations. Informed consent refers to the ongoing process of informing clients about their therapy for the purpose of helping them make autonomous decisions pertaining to it. The aim is for clients to become involved, educated, and willing participants in the helping process.

Health Insurance Portability and Accountability Act (HIPAA) of 1996 is an act passed by Congress to promote standardization and efficiency in health care industry. HIPAA is a federal law that contains detailed provisions regarding client privacy, informed consent, and transfer of records.

HIPAA privacy rule was designed to give patients more rights and more control over their health information.

Informed consent document refers to a written document, which the counselor and client discuss, that defines boundaries and clarifies the nature of the basic counseling relationship between counselor and client.

Law provide guidelines for acceptable professional practice, yet neither offers clear-cut answers to most situational problems. Law defines the minimum standards society will tolerate, which are enforced by government.

Malpractice is generally defined as the failure to render proper service, through ignorance or negligence, resulting in injury or loss to the client.

Managed care model is characterized by time-limited interventions, cost-effective methods, careful monitoring of services, and preventive more than curative strategies.

Mandatory ethics describes a level of ethical functioning wherein counselors act in compliance with minimal standards, acknowledging the basic rules of practice.

Process notes (or psychotherapy notes) deal with client reactions such as transference and the therapist’s subjective impressions of a client. These notes are not meant to be readily disclosed to others.

Professional negligence consists of departing from the usual standard of practice or not exercising due care in fulfilling one’s responsibilities.

Progress notes or the client’s clinical records, are required by law. These notes are behavioral in nature and address what people say and do.

Risk management is the practice of focusing on the identification, evaluation, and treatment of problems that may injure clients, lead to filing of an ethics complaint, or lead to a malpractice action.

Standards of care refer to standards that are commonly accepted by the profession and are considered as the acceptable standard practice in the community.

Utilization review refers to the use of predefined criteria to evaluate treatment necessity, appropriateness of therapeutic intervention, and therapy effectiveness.

Copyright © 2019 Cengage Learning. All rights reserved.

Copyright © 2019 Cengage Learning. All rights reserved.