​OPTION #1: Dual Relationships

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Some say that multiple relationships are inevitable, pervasive, and unavoidable and have the potential to be either beneficial or harmful. Submit a paper analyzing both sides of this issue. Account for each of the following items:

  1. Identify and explain the potential benefits of multiple relationships, and evaluate the argument that they cannot be dealt with by simple legislative or ethical mandates.
  2. Examine the other side of this issue, evaluating the argument that multiple relationships are unethical, and provide reasons.
  3. Compare and contrast the two arguments, noting any contractions, tensions, or fallacies that arise from the comparison. Is one position stronger or more efficacious than the other?

Instructions:

  • Write a 3-4 page paper not including the title and reference pages, which are required.
  • Be sure your answer names and discusses relevant established ethical codes. Discuss and cite the textbook readings and/or at least one additional credible or scholarly source to support your analysis and positions.
  • Your paper must be properly cited and formatted according to the CSU-Global Guide to Writing and APA.

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Ethical Implications of Trends in Technology Courtney L. Klaus and Timothy S. Hartshorne Abstract Technological advancements are ubiquitous in society and clearly have implications for the provision of mental health services. But with any innovation comes ethical concerns, and the use of technology raises questions about confidentiality, profes­ sional boundaries, and competence. This article addresses ethical concerns with the use of email, texting, telephone, videoconferencing, and social media. Keywords: Individual Psychology, ethics, technology, email, texting, telephone, videoconferencing, social media This article addresses ethical issues that emerge with the use of technol­ ogy in the provision of counseling and psychotherapeutic services. We live in a technological and information age that is well beyond anything that could have been imagined by Alfred Adler. Through technology, services can expand and extend past the confines of a single therapy room. The con­ struct of social interest, however, implies a concern for the welfare of the larger communities in which we live. Feibleman (1944) suggests that this points to an Adlerian ethic: that which is good serves more than the unique individual; it serves the larger "unlimited" or "ideal" society. Feibleman (1944) quotes Adler as saying, "Anything that we estimate as valuable, good, right, and normal, we estimate simply in so far as it is 'virtue' from the point of view of an ideal society" (p. 294). In an earlier article, Feibleman (1937) suggests that beyond the limited communities where we live are other, more distant communities, each connected with even more distant communities, expanding in an "unlimited" direction, and to which we all essentially have a responsibility. Although this seems an essential Adlerian ideal—that we develop a sense of connection in our families of origin, and that as we develop and mature, our sense of connection, and then also responsibility, expands— it becomes an even greater reality with the Internet and communications technology. Now therapeutic services can be provided over not just great distances, but essentially all distances: distance is no longer a limitation. Each one of us can reach the "unlimited community." Reaching and contacting unlimited communities is now possible, but how are we to think about our responsibilities, both as human beings and The Journal o f Individual Psychology, Vol. 71, No. 2, Summer 2015 ©2015 by the University of Texas Press Editorial office located in the College of Education at Georgia State University. Published for the North American Society of Adlerian Psychology. 196 Courtney L. Klaus and Timothy S. Hartshorne as therapists? The Adlerian ethic to ensure that the connection we make is a "virtue" for the larger, ideal society has to fundamentally guide us in the use of distance technology. We live in a world of technological marvels that have and w ill continue to affect the work of mental health practitioners. New opportunities for breaches to confidentiality, challenges to boundary issues and multiple relationships, and concerns about appropriate train­ ing and supervision are emerging. The following analysis addresses the advantages, disadvantages, ethical concerns and considerations, and rec­ ommendations in regard to approaching some of the uses of technology in the counseling relationship. E-mail Advantages Perhaps one of the most obvious advantages of e-mail is the conve­ nience it offers. E-mail enables a therapist and client to communicate at any time, even when they are not in the same location (Recupero & Harms, 2010). This convenience also allows for those who are physically unable to make it to an office to receive services. Recupero and Harms (2010) state that e-mail may allow clients to express more honest information about their situation because they might feel less vulnerable than when sitting across from someone in an office. Not only does this allow clients to potentially convey more honest emotions; it also allows them more time to process and develop perhaps a more thoughtful response. Disadvantages One of the more serious disadvantages to e-mail is that information is more vulnerable to being hacked. Every client and therapist should be aware that just because e-mails have been deleted does not mean they are truly "erased"; Internet service providers (ISPs) can easily recover them. Human error can also be an issue: e-mail can accidentally be deleted, buried among other e-mails in an inbox, or sent to the wrong address, resulting in expo­ sure of the client's private information (Welfel & Heinlen, 2010). Another disadvantage of e-mail is that one does not truly know with whom he or she is communicating. For example, consider a client who is in an abusive relationship and has a partner who monitors client communication heavily. As a therapist, by communicating via e-mail and unknowingly exposing in­ formation to an abuser, beneficence is in question, as the client could be put in harm's way. Therefore, having a password or some kind of security log-in when using e-mail in this setting is highly advised. Ethical Implications of Trends in Technology 197 Ethical Considerations "Out of one thousand randomly selected American Counseling As­ sociation members who answered surveys— most respondents perceived providing direct clinical services by means of email to be unethical" (McMinn, Buchanan, Ellens, & Ryan, 1999, p. 168). It is important to note that this research was published in 1999. However, it gives perspective on how individuals involved in the mental health field feel about conduct­ ing therapy via e-mail. One of the most concerning ethical issues when e-mailing clients is confidentiality. As mentioned previously, ISPs can gain access to e-mails at any time. It is also important to make clients cognizant of the fact that their information is not secure when using a work-based computer, as often companies can gain access. Licensure is another issue if therapist and client reside in different states. State laws should also be con­ sulted (Recupero & Harms, 2010). Recommendations The newly released Section H of the American Counseling Association's (ACA, 2014) Code o f Ethics offers some guidance in these areas. In regard to confidentiality, Section H.2 stresses the importance of therapists recogniz­ ing the limitations of technology, and therapists' responsibility in making their clients aware of this. Section H.1.b offers guidance when it comes to licensure, stating that counselors must be aware of the regulations for their location, as well as their client's location, and that they must follow those regulations in the counseling relationship(s). Overall, "clinicians need to develop policies and procedures for responding to client email and communicate them to clients as part of the informed consent process in psychotherapy" (McMinn etal., 1999, p. 172). Texting and Telephone Advantages An advantage of texting allows clients the ability to chart moods in real time rather than having to recall their experiences a week or so later in session (Merz, 2010). Texting can also be used to check in with clients for recommendations and follow-up, as well as to offer support and enhance communication (Merz, 2010). Regarding phone use in the therapeutic rela­ tionship, Welfel and Heinlen (2010) found that adolescents reported feeling an increased sense of privacy and more safe and "less emotionally exposed" when using therapeutic services from a telephone call center. 198 Courtney L. Klaus and Timothy S. Hartshorne Disadvantages A major disadvantage of communicating with clients via text is that it allows for a greater risk of boundary issues, especially if client and therapist do not understand or practice appropriate times and subjects for commu­ nicating via text. It is therefore important that therapists communicate and abide by set rules with clients when texting. Other disadvantages of texting are similar to those of e-mail: human error and the inability to know with whom the therapist is truly communicating. A disadvantage of texting and telephone therapy, critics argue, is that, as with other forms of technology services, "without visual cues, counselors w ill be unable to develop a strong therapeutic relationship or . . . important clinical data w ill be overlooked" (Saunders, 2010, p. 88). Another challenge that telephone therapy poses is limiting a therapist's clientele base to those who can be clearly understood over the telephone (Saunders, 2010). Ethical Considerations As with any form of technology, the biggest ethical consideration is confidentiality. Clients and therapists must understand that texting is not a secure form of ensuring client confidentiality. Also, as mentioned previ­ ously, professional boundaries are another concern with texting. Although today's digital phones make hacking less of a problem, it is still important to recognize and inform clients that one cannot guarantee complete security when utilizing technology (Saunders, 2010, p. 89). In addition, privacy for phone conversations must be ensured. Recommendations When considering the use of texting, or any form of technology, for counseling purposes, therapists should review Section H.2 of the ACA's 2014 Code o f Ethics in regard to confidentiality. Merz (2010) states that when implementing texting, it is important to shield the device screen so that others cannot view it, or it should be used only in private locations along with privacy filters. In regard to preventing potential boundary is­ sues, therapists should refer to Section H.4.b of the Code o f Ethics, which states "counselors discuss and establish professional boundaries with cli­ ents regarding the appropriate use and/or application of technology and the limitations of its use within the counseling relationship" (ACA, 2014). Again, Section H.2 of the Code o f Ethics should be referred to for concerns per­ taining to confidentiality. In regard to security, however, one should refer specifically to Section H.2.d of the Code o f Ethics, as it states that coun­ selors are responsible for using "current encryption standards within their websites and/or technology-based communications that meet applicable legal requirements" (ACA, 2014). Therefore, it is important for therapists to clearly communicate with clients about the specifics of how telephone Ethical Implications of Trends in Technology 199 therapy might be offered, including number and length of sessions, and how billing w ill occur (Saunders, 2010). Videoconferencing Advantages Perle et al. (2013) found that counseling conducted through videoconferencing resulted in a wide range of benefits, including reduced stigma of attending services in a mental health clinic, the ability to reach a wider range of clientele (e.g., those in underserved areas), more convenience in terms of time and transportation, and ability to provide services to those who are physically unable to attend a session in an office. Perle et al. surveyed 308 doctoral-level students and 409 licensed psychologists in regard to their personal opinions on counseling conducted through videoconferencing and other computer-based interventions. More than half of participants "en­ dorsed the use of synchronous telehealth interventions (using web cameras) for generalized anxiety disorder (70.2%), agoraphobia (64.2%), dysthymia (63.3%), social anxiety (62.9%), specific phobia (61.4%), major depressive disorder (55.5%), panic disorder (53.8%), and obsessive-compulsive dis­ order (51.2%)" (Perle et al., 2013, p. 104). Disadvantages Although the participants in Perle et al.'s (2013) study gave some in­ sight into advantages of videoconferencing, the authors also suggested some negatives, including lack of research (63.0%), lack of privacy (46.0%), confidentiality concerns (47.4%), crisis situations (57.6%), billing (19.19%), licensure (29.3%), and lack of ethics coverage (44.6%). Overall, Perle et al. found that only 21.3% of participants agreed that they had adequate train­ ing and experience to effectively deliver therapy via videoconferencing. Therefore, although therapists might find videoconferencing a useful re­ source in some circumstances, the research suggests that not many therapists feel comfortable regarding their competence to do so. Another disadvantage of videoconferencing and other online technology is "glitching," or "losing" a client during session because of technical errors or a faulty connection, which could be detrimental to a client's progress. Ethical Concerns Several ethical concerns arise with videoconferencing therapy. First, there may be an ethical imperative to provide therapy to individuals who live in remote areas and do not have ready access to therapists, and so it would be inappropriate to w ithhold video therapy from them (Simpson & Morrow, 2010). Second, state licensure and regulations vary across borders, and it is 200 Courtney L. Klaus and Timothy S. Hartshorne essential for therapists to research and comply with the legal and ethical im­ plications of "crossing" those boundaries (Simpson & Morrow, 2010). Third, as always with technology, confidentiality is the biggest concern, and it is up to therapists to do everything within their power to uphold this standard. Perhaps one of the biggest concerns is competence. Unfortunately, not every individual is educated about how to troubleshoot glitching or other com­ puter issues. Telehealth.org recommends having an information technology (IT) professional available to assist when issues arise, and that clients, along with therapists, receive training from IT professionals to understand how to operate the systems they are using (Perle et al., 2013). Recommendations In regard to confidentiality, therapists should refer to Section H.2 of the ACA's 2014 Code o f Ethics. Section H.1.b addresses legal issues, and Section H.2.d addresses issues of security. Perle et al. (2013) recommend that for further training in videoconferencing therapy, mental health profes­ sionals direct themselves to the TeleMental Health Institute (http://telehealth .org/special-training/#), which offers training and continuing education in videoconferencing therapies. Also, as always, clients need to be fully in­ formed of the risks and benefits of videoconferencing therapy (Simpson & Morrow, 2010). Social Media Advantages Hampton (2013) found in a comparative study that Internet users actu­ ally score four points higher on an overall scale of reported social support than non-Internet users. Hampton also found that daily Facebook use is equivalent to at least half the support one might get from a marriage. Although this is interesting information, perhaps the biggest advantage to social media is the ability to spread knowledge to an unlimited audience. Social media provides therapists the opportunity to get more information out to clientele and Internet users in general. One could say that this is perhaps a new means of psychoeducation, which in the past was limited to only mental health professionals and those who received their services. It can also be a way for a practice to stay in touch with clients as a group. Some practices use Facebook as a way to let clients know about cancella­ tions and scheduling changes. Disadvantages One disadvantage with some forms of social media, especially Facebook, is "friending," which raises boundary issues in the relationship (Luo, Ethical Implications of Trends in Technology 201 2009). Therapists do not need to accept a friend request from a client, but clients may still be able to locate personal information about the therapist, potentially by having mutual friends, or being tech-savvy (Nicholson, 2011). Another concern is that of privacy. Lehavot, Barnett, and Powers (2010) found that 27% of graduate students surveyed in their study indicated that they had looked up information on their clients online. This creates several issues. "For example, if a client were to tell a psychologist that he or she has been very successful in not smoking for several weeks, but through the 'friend of a friend' on a social networking site, the psychologist discovers photos of the client smoking at a recent party, what does the psychologist do with this information?" (Nicholson, 2011, p. 21 7). Therefore, therapists need to set personal boundaries not only for themselves when it comes to privacy but also for clients' vulnerable online information. It is important to allow for clients' autonomy inside and outside of sessions, despite any temptations to look for clients on social media. Ethical Concerns The two main concerns with social media in relation to mental health modalities are dual relationships and boundary-related issues. One can­ not be both a friend on Facebook and a therapist. To address problems of a "slippery slope" effect with respect to crossing or violating boundaries, counselors need to develop and follow guidelines for handling clients who find their profile, as well as for themselves in terms of searching for their clients online (Simpson & Morrow, 2010). Recommendations In regard to boundary-related issues with social media, practitioners should consult Section H.4.b, Professional Boundaries in Distance Counsel­ ing, in the ACA's 2014 Code o f Ethics, which stresses the importance of a professional relationship with clients and the fact that professional bound­ aries need to be discussed and established, particularly as they pertain to technology and its use in a counseling relationship. In regard to this, Younggren and Gottlieb (2004) have provided a useful model for therapists to use when experiencing a "multiple relationship dilemma" (p. 255) or boundary issues. The model is a series of questions about the necessity of the relationship, potential harm from a dual relationship, potential benefits to the relationship, potential disruptions to therapy by the dual relationships, and therapist objectivity. Also, as a precautionary measure, Lannin and Scott (2013) recommend that therapists consult professional and personal liabil­ ity insurance representatives regarding coverage for social media. Last, as always, confidentiality is an important issue to remain cognizant of, and counselors should refer to Section H.2.b of the Code o f Ethics with any confidentiality-related concerns. 202 Courtney L. Klaus and Timothy S. Hartshorne Discussion As technology propels communication forward to create a world that is not so unlimited anymore, an important question is what this w ill do for careers in the mental health arena. W ith technological advances in com­ munication, there is no question that technology w ill continue to affect the counseling realm. Three primary ethical issues emerge from the considerations of distance technology: confidentiality, boundary issues, and competence. Confidentiality is the reason talk therapy works. W ithout confidentiality, individuals w ould not feel comfortable sharing their intimate thoughts and experiences. Therefore, it is concerning to think that therapists are comfort­ able with utilizing technological modalities that are risky when it comes to ensuring client confidentiality w ithin the therapeutic relationship. Counsel­ ors need to reflect on their own standards and comfort levels when it comes to technology; and w ithout question, counselors need to be careful and re­ sponsible when it comes to creating a safe environment for their clients. Communication and expectations for boundaries in the counseling relationship provide a healthy environment for client growth. However, when boundaries start to bend w ithin the counseling relationship, issues can arise, as oftentimes the relationship w ill start to evolve into more of a friendship or even a romantic relationship. This ultimately ruins the po­ tential for any further therapeutic work to be done. In regard to the use of technology in counseling, boundaries are more apt to be broken because of the accessibility and informality that technology offers in terms of commu­ nication. Therefore, it is extremely important for therapists to develop rules for themselves and clients when implementing different forms of technology w ithin therapy. Competence is vital to the counseling profession. If a therapist does not understand how to help a certain client population or implement a particu­ lar technique in the proper way, it is advised that he or she not do so. This standard has been established in the profession to ensure that clients are not put at risk. Technology is a newer force in society that continues to grow and change. Therefore, if a therapist is interested in using different forms of technology in the counseling relationship, there are several things he or she must evaluate. One, does the therapist understand how to operate the tech­ nological device? Two, does the therapist feel comfortable doing so? Three, does the therapist understand how to use the device in a therapeutic way? By asking these three questions and by consulting the ACA's 2014 Code o f Ethics, a therapist can assess his or her own competence level in regard to technology use w ithin therapy. Whether technology is more of a detriment than a help to therapy is still up for debate. Because technology is still a fairly new phenomenon in the realm of counseling, therapists considering Ethical Implications of Trends in Technology 203 implementing different forms of technology in therapy must ask themselves, "W hat am I comfortable with?" If a therapist does not feel comfortable or competent in delivering therapy via some form of technology, then he or she should not put clients at risk by doing so. However, given the technologi­ cal advances that are making alternative forms of delivery readily available, therapists may feel ethically bound to receive training in their appropriate use. Adler could not have anticipated the technological advances that are affecting our society. It is ethically imperative that Adlerian therapists con­ sider the implications of these advances on society and how technology can support progress toward the "unlim ited" and "ideal" society. References American Counseling Association. (2014). ACA code o f ethics. Alexandria, VA: Author. Feibleman, J. (1937). Moving toward the unlimited community. International Journal o f Individual Psychology, 3(4), 309-319. Feibleman, J. (1944). Individual Psychology and the ethics of Peirce. Journal o f General Psychology, 31, 293-295. Hampton, K. N. (2013). New communication technologies and the nature of community. Family Therapy Magazine, 12(2), 10-15. Lannin, D. G., & Scott, N. A. (2013). Social networking ethics: Developing best practices for the new small world. Professional Psychology: Re­ search and Practice, 44, 135-141. Lehavot, K., Barnett, J., & Powers, D. (2010). Psychotherapy, professional relationships, and ethical considerations in the MySpace generation. Professional Psychology: Research and Practice, 41, 160-166. d o i: 10 .1037/a0018709 Luo, J. S. (2009). The Facebook phenomenon: Boundaries and controversies. Primary Psychiatry, 16, 19-21. M cM inn, M. R., Buchanan, T., Ellens, B. M., & Ryan, M. K. (1999). Technology, professional practice, and ethics: Survey findings and im pli­ cations. Professional Psychology: Research and Practice, 30, 165-172. Merz, T. A. (2010). Using cell/m obile phone SMS for therapeutic interven­ tion. In K. Anthony, D. M. Nagel, & S. Goss (Eds.), The use o f technology in mental health: Applications, ethics and practice (pp. 29-38). Springfield, IL: Thomas. Nicholson, I. R. (2011). New technology, old issues: Demonstrating the relevance of the Canadian code of ethics for psychologists to the eversharper cutting edge of technology. Canadian Psychology, 52, 215-224. 204 Courtney L. Klaus and Timothy S. Hartshorne Perle, J. G., Langsam, L. C., Randel, A., Lutchman, S., Levine, A. B., Odland, A. P.,. . . Marker, C. D. (2013). Attitudes toward psychological telehealth: Current and future clinical psychologists' opinions of Internet-based interventions. Journal o f Clinical Psychology, 69, 100-113. doi:http:// dx.doi.org/10.1002/jclp.21912 Recupero, P. R., & Harms, S. (2010). Using email to conduct a therapeutic relationship. In K. Anthony, D. M. Nagel, & S. Goss (Eds.), The use o f tech­ nology in mental health: Applications, ethics, and practice (pp. 3-14). Springfield, IL: Thomas. Saunders, D. E. (2010). Using telephone for conducting a therapeutic re­ lationship. In K. Anthony, D. M. Nagel, & S. Goss (Eds.), The use of technology in mental health: Applications, ethics and practice (pp. 8593). Springfield, IL: Thomas. Simpson, S., & Morrow, E. (2010). Using videoconferencing for conducting a therapeutic relationship. In K. Anthony, D. M. Nagel, & S. Goss (Eds.), The use o f technology in mental health: Applications, ethics, and prac­ tice (pp. 94-103). Springfield, IL: Thomas. Welfel, E. R., & Heinlen, K. T. (2010). Ethics in technology and mental health. In M. A. Cucciare & K. R. Weingardt (Eds.), Using technology to support evidence-based behavioral health practices: A clinician's guide (pp. 267-290). New York, NY: Taylor and Francis. Younggren, J., & Gottlieb, M. C. (2004). Managing risk when contemplating multiple relationships. Professional Psychology: Research and Practice, 35, 255-260. Courtney L. Klaus (klaus1cl@cmich.edu) is a graduate student in the master's-level counseling program at Central Michigan University. She hopes to work with college students in the future and is currently doing her internship at Central Michigan University's Counseling Center. She is a member of Sexual Aggression Peer Advocates, a paraprofessional organiza­ tion on campus that runs a 24-hour crisis line and chat system online to help survivors of intimate partner violence. She also currently volunteers at Women's Aid women's shelter in Mount Pleasant, Michigan, and has worked several different jobs on campus, as well as several positions as a caregiver off-campus. Timothy S. Hartshorne (harts1ts@cmich.edu) is professor of psychology at Central Michigan University. He is a Diplomate of the North American Society of Adlerian Psychology and chair of its ethics committee. Copyright of Journal of Individual Psychology is the property of University of Texas Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. Dual relationships in training This month's dilemma Val is a training therapist at a counselling institute where she also facilitates experiential groups for trainee counsellors. Steve, a trainee in a group that has recently come to an end, had shared in the group his experience of being emotionally abused by his father as a child. Val has since heard from Steve, who has explained that a situation has arisen with his current training therapist, Mike. Steve tells Val that Mike had encouraged him to participate in a retreat he was leading. Steve was reluctant but Mike persuaded him, saying he thought it would support the work they were doing in therapy. Steve has recently returned from the retreat and found the experience troubling. He doesn't want to return for further sessions with Mike and, having had a positive experience of Val from the experiential group, wants her to be his training therapist instead. What should Val do? Please note that opinions expressed in these responses are those of the writers alone and not necessarily those of the column editor or of BACP. Boundary incursions Keith Silvester BACP senior accredited integrative psychosynthesis psychotherapist, counsellor and supervisor, and former training director There are some unexplained inferences in this dilemma. The first is that there is an automatic link between the emotional abuse suffered by Steve from his father and the relationship with Mike, the training therapist. Connected with this is the assumption that Steve's experience on Mike's retreat was a collusion or re-enactment of that abusive situation and was harmful to Steve. The third assumption is that Mike has crossed some crucial boundary by changing the nature of the therapeutic contract with his training client. Yes, we know that the experience was 'troubling' for Steve, but we do not yet know exactly why. Val, the ex-experiential group leader, could easily be drawn into a drama triangle as a 'rescuer', and she should definitely be wary of this. It would perhaps be better for her to spend some time with Steve finding out what exactly has been troubling for him, without assuming that Mike is somehow to blame for the way he is feeling. If it turns out that a boundary has been crossed insensitively or inappropriately, then Val would be within her remit as a responsible trainer to encourage Steve to make some sort of complaint. But this would be a grave step to take in relation to a fellow professional. It would perhaps be better for Val to encourage Steve to work it through directly with Mike and try to resolve it as 'unfinished business' between them. Although this might be scary for Steve, the potential gains in terms of empowering him to confront Mike would be a real growing point. Steve's request for Val to now become his training therapist also puts her in a dilemma. She does not need to take on this dilemma as her own, and it would be a good strategy to name and share it with Steve so that he recognises that he is putting her in this position. This would help Steve, as a trainee, to recognise that the world is complex and that responsibility for such complexity needs to be shared. In this way he might come to see that he is putting Val in a difficult position that happens to affect her professional relationship with Mike, and possibly the training institute. There is a further aspect that may be uncomfortable to those who see boundaries as sacrosanct: not all boundary overlaps or incursions need be boundary 'abuses'. Yes, Steve was emotionally abused as a child, but he is also an adult in training. The assumed re-enactment that took place between him and Mike could be seen as an invitation to heal the painful relationship between Steve and his father. Although it would appear that this attempt by Mike (whether conscious or unconscious) backfired in a harmful way for Steve, it could also be viewed as a challenge or opportunity for Steve to work through and go beyond that painful relationship with his father by getting closer to Mike. The word 'abuse' is often assumed to refer to an absolute, objective and thus reified situation, creating an automatic and incontrovertible Victim'. Yet in most cases when the word is applied it is relative and subject to how the experiencer construes the situation or takes part in an archetypal enactment of something happening. In this, Steve has some choice in the matter and could rise above it. Trainers should not also be therapists Jo-Ann Roden Psychotherapist and supervisor in private practice, secondary school counsellor and tutor at Re-Vision Responding to this dilemma, my first thought concerns the training institute's training therapist policy. My sense (and this is grounded in the policy at the centre where I work as a tutor) is that training staff ought not to act as therapists (ie in a dual role) to current students of that institute. If this policy were the norm, then the dilemma would not have occurred in the form outlined here. Steve -- presuming he is a current student of the institute -- has approached Val, a current experiential group facilitator at the same institute, for training therapy. Even if Steve is not currently in Val's group, I'm imagining that Val will be in professional contact (ie in team meetings etc) with Steve's current trainers or group facilitators, and therefore there is the possibility of conflicts of interest and concerns over 'leaky containers'. The duality in the role would also bring the possibility of creating 'special' relationships with 'special' students and 'special' members of staff. Second, turning to the situation with Mike, is he also a member of the training team at this institute? If so, then again we have the dilemma as above around conflicting roles etc. On top of this we also have Steve's suggested vulnerability due to his childhood abuse experiences. Steve was 'persuaded' by Mike (suggesting an imbalance in the power dynamic that was used to Mike's advantage). This would stand regardless of whether Mike was also a trainer at the institute, but it is certainly compounded by that, if it is the case. Here we find challenges to the BACP Ethical Framework principles of non-maleficence and autonomy. My sense is that Val should meet Steve and, while empathising with his struggle, she should decline his request to be his training therapist, refer him to an experienced practitioner outside the training organisation, and then engage her staff group in a policy discussion about the boundaries of relationships between students and trainers. At Re-Vision we have a policy that states a one-year 'no go zone' for pre- and post-training therapy student therapeutic relationships. This is in line with UKCP standards and with BACP's Ethical Framework in relation to dual relationships. My sense is that this boundary is an important, utilitarian protective factor. If it were not in place, while harm may not come to all clients, it nevertheless would protect students (and trainers) from that particular potential. Potential for breach of trust Heather Dale Senior Lecturer, University of Huddersfield, and therapist in private practice As I understand this dilemma, Val is currently a trainer on Steve's course and has also facilitated an experiential group in which he has been a participant. Now he wishes her to take on a third role as his individual therapist. However, his relationship with his current therapist foundered when they entered into a dual relationship, so asking Val to do the same sounds as if she might be being invited into a psychological game that may well end badly for both of them. A central therapeutic issue regarding childhood abuse is that it is a breach in the trust in the relationship between a child and an adult. While Steve is no longer a child, in some way that we are not told about Mike has breached the trust that he had with Steve. This may or may not be a rerun of the original abuse, but clients, particularly if they have been abused, can often feel violated in some way when a therapist has encouraged them to enter into a dual relationship, however benevolently intended. Therefore, as his trainer, Val's first conversation with Steve should be to encourage him to discuss with Mike what has gone wrong between them. Steve is himself training as a therapist, so he needs to have learned how to discuss difficult relational issues in therapy. Given his childhood abuse, talking through his feelings with Mike may be an important part of the healing process, particularly if the early abuse has involved the keeping of a secret. If, having attempted to resolve the difficulties with Mike, Steve is still unhappy, only then should Val agree to him finding another therapist. If she does agree, she then has to decide whether to accede to his request to take on the role herself. However, if she does accept his request to be his therapist, she must be aware that, like Mike before her, she will be entering into a dual relationship in which she will be both his trainer and his therapist. Steve has initiated this request, but I wonder what his unconscious motive might be, as he has already experienced a dual relationship that has gone badly wrong. While Steve experienced Val as a good group facilitator, that may not translate into her being a good individual therapist for him. Val needs to be very careful about her motives, especially as she will presumably charge for this service, so it might be argued that she has a financial incentive for encouraging Steve to finish the therapeutic relationship with Mike and take that role for herself. In addition, if it goes wrong, as it might well, then where will Steve turn? When his relationship with Mike went wrong, he very sensibly turned to Val as his trainer, but if she has both roles then the circle of trainer, supervisor and therapist becomes a closed one. Maintaining clear boundaries Divine Charura UKCP registered psychotherapist and Senior Lecturer at Leeds Beckett University The potential outcomes to clients of therapists' suggestions or 'encouragements', however naive or well-intended, can be serious. In our recently published book, An Introduction to the Therapeutic Relationship in Counselling and Psychotherapy (Sage; 2015), my colleague Stephen Paul and I noted the importance of therapist awareness of transference and countertransference dynamics in the therapeutic relationship, as well as the ethical dilemmas that can result from therapists' suggestions, actions or behaviours that may lead to a re-stimulation of unresolved matters that brought the client to therapy in the first place. Therapists therefore need to maintain clear professional boundaries, follow relevant codes of ethics and practice and make full use of supervision. In the dilemma posed in this scenario, Mike's awareness of the potential transferential dynamic between him and Steve, which could have related to his relationship with his father, is unclear. Mike's encouragement of Steve to participate in a retreat he was leading may have been genuine and well intended. However he should have considered the BACP Ethical Framework, and in particular the principles relating to ensuring the integrity of the practitioner-client relationship; being trustworthy and honouring the trust placed in the practitioner (fidelity), and the commitment to avoiding harm to the client (non-maleficence). It could be considered that Mike, being in a position of power as the therapist, had encouraged his client to participate in something that benefited him as the therapist. The ethical guidelines of most counselling and psychotherapy regulatory bodies -- BACP, UKCP, BPS etc -- warn of the dangers of dual relationships arising when the practitioner has two or more kinds of relationship concurrently with a client -- in this case, the dual relationship of client and trainee. It is clear that the existence of a dual relationship with a client is seldom neutral and can have a powerful beneficial or detrimental impact, which may not always be easily foreseeable. As such, the complexities that have resulted from Mike's behaviour can guide us in answering the question of what Val should do. Val should talk to Steve and help him to understand the 'troubling' experience of being on the retreat with Mike, and then she should encourage him to share his feelings with Mike. Steve has a right to end therapy with Mike if he then decides to. From my experience of working in a university that offers therapy training programmes, training therapists are obliged to adhere not only to their professional registration body guidelines but also to the training institution's commitment to ensuring safe and competent practice. If it's clear that what Steve has reported as a 'troubling experience' is indeed unethical practice, Val also has a responsibility to report Mike's malpractice to his professional body. Last, Val should consider carefully the question of whether to take Steve on as her client. It would be a dual relationship, which could impair her ability to be objective if problems arise that may not be foreseeable at present. It would be advisable for her to have a discussion with Steve about finding a different therapist. If it does become clear that the case is as presented, it would also be advisable for the counselling institute to consider removing Mike from their list of recommended training therapists. May's dilemma Anjali works from home in private practice in a house on a busy street. It has one parking space, which is used by her husband Nikhil when he returns from work. During the day those of Anjali's clients who drive to their sessions use the space to park their cars. Anjali has noticed that one of her clients, Deborah, sits in her car without moving for some time after her session, but she has not brought this up with Deborah. Frequently Nikhil has returned home from work to find Deborah sitting in her car, and has had to find somewhere else to park, further down the road. One day, overcome with frustration, Nikhil confronts Deborah and asks her why she doesn't make any effort to move out of the space when she can see him waiting to park. He tells Anjali what has happened. While he recognises the potential impact of his behaviour on Deborah, he feels that he was justified. In her next session, Deborah does not mention the incident to Anjali. What should Anjali do? Issues and Ethics in the Helping Professions, 9th Edition by Gerald Corey, Marianne Schneider Corey, Cindy Corey, and Patrick Callanan with Michelle Muratori, Johns Hopkins University © 2015. Cengage Learning. All rights reserved. Chapter 7 MANAGING BOUNDARIES AND MULTIPLE RELATIONSHIPS © 2015. Cengage Learning. All rights reserved. Boundary Crossings and Multiple Relationships The rationale for abstaining from boundary crossings or multiple relationships involves the potential for therapists to misuse their power to influence and exploit clients for their own benefit and to the clients’ detriment. © 2015. Cengage Learning. All rights reserved. Boundary Crossings and Multiple Relationships The viewpoints on multiple relationships vary: – Some focus on the problems inherent in multiple relationships. – Others view them as common, inevitable, unavoidable, normal, and a healthy part of communal life in many settings. © 2015. Cengage Learning. All rights reserved. Boundary Crossings versus Boundary Violations Boundary crossing: – A departure from commonly accepted practices that could potentially benefit clients – Example: Attending a student’s school play or sports event to build a positive relationship with him or her © 2015. Cengage Learning. All rights reserved. Boundary Crossings versus Boundary Violations Boundary violation: – A serious breach that results in harm to clients and is therefore unethical – Example: A gradual erosion of boundaries that leads to sexual exploitation of the client © 2015. Cengage Learning. All rights reserved. Minimizing Risks in Multiple Relationships Identify measures aimed at minimizing the risks: – Set healthy boundaries from the outset – Secure informed consent of clients – Discuss both potential risks and benefits – Consult with other professionals to resolve any dilemmas © 2015. Cengage Learning. All rights reserved. Minimizing Risks in Multiple Relationships Identify measures aimed at minimizing the risks: – Seek supervision when needed – Document in clinical case notes – Examine your own motivations – Refer when necessary © 2015. Cengage Learning. All rights reserved. Managing Multiple Relationships: Small Community Practitioners who work in small communities often have to blend several professional roles and functions. They have to become an integral part of the community to be accepted as a credible mental health resource. © 2015. Cengage Learning. All rights reserved. Managing Multiple Relationships: Small Community If these practitioners isolate themselves from the surrounding community, they are likely to alienate potential clients and thus reduce their effectiveness in the settings where they work. © 2015. Cengage Learning. All rights reserved. Prior to Establishing a Bartering Relationship Evaluate whether it puts you at risk of impaired professional judgment Determine the value of goods or services in a collaborative fashion Determine appropriate length of time for arrangement Document arrangement and consult with experienced colleagues or supervisors © 2015. Cengage Learning. All rights reserved. Bartering Guidelines to clarify barter arrangements: – Minimize unique financial arrangements – If bartering is used, it is better to exchange goods rather than services – Both therapist and client should have a written agreement for the compensation by bartering – If a misunderstanding develops, the matter should be dealt with by a mediator, not by you and your client © 2015. Cengage Learning. All rights reserved. Accepting Gifts When deciding whether or not to accept a gift from a client, ask yourself: – What is the monetary value of the gift? – What are the clinical implications of accepting or rejecting the gift? © 2015. Cengage Learning. All rights reserved. Accepting Gifts When deciding whether or not to accept a gift from a client, ask yourself: – When in the therapy process is the offering of a gift occurring? – What are my motivations for accepting or rejecting a gift? – What are the cultural implications of offering a gift? © 2015. Cengage Learning. All rights reserved. Disadvantages of Socializing with Clients Therapists may not challenge clients they know socially because of a need to be liked and accepted by the client. Counselors’ own needs may be enmeshed with those of their clients to the point that objectivity is lost. © 2015. Cengage Learning. All rights reserved. Disadvantages of Socializing with Clients Counselors are at greater risk of exploiting clients because of the power differential in the therapeutic relationship. Former clients may need you more as a therapist at some future time than as a friend. © 2015. Cengage Learning. All rights reserved. Sexual Attractions in Therapy Attraction to clients is a prevalent experience among both male and female therapists. Simply experiencing sexual attraction to a client, without acting on it, makes the majority of therapists feel guilty, anxious, and confused. © 2015. Cengage Learning. All rights reserved. Sexual Attractions in Therapy There is a distinction between finding a client sexually attractive and being preoccupied with this attraction. Neglecting to attend to family-of-origin issues can lead to blind spots such as being attracted to clients. © 2015. Cengage Learning. All rights reserved. Dealing with Sexual Attractions To minimize the likelihood of sexual transgressions: – Learn to recognize sexual attractions and how to deal with these feelings constructively and therapeutically. – Seek professional support during times of loss or crisis. – Examine and monitor feelings and behaviors toward clients continually. © 2015. Cengage Learning. All rights reserved. Dealing with Sexual Attractions To minimize the likelihood of sexual transgressions: – Know the difference between having sexual attraction to clients and acting on this attraction. – Learn about the possible adverse consequences for clients and therapists who engage in sexual activity. © 2015. Cengage Learning. All rights reserved. Dealing with Sexual Attractions To minimize the likelihood of sexual transgressions: – Establish and maintain clear boundaries when a client makes sexual advances toward you. – Terminate the therapeutic relationship when sexual feelings obscure objectivity. – Recognize that direct explicit disclosures of sexual feelings can run the risk of harming clients and may therefore be unethical. © 2015. Cengage Learning. All rights reserved. Dealing with Sexual Attractions To minimize the likelihood of sexual transgressions: – Rather than making any explicit communication of sexual feelings for clients, acknowledge caring and warmth within the therapeutic relationship. © 2015. Cengage Learning. All rights reserved. Dealing with Sexual Attractions To minimize the likelihood of sexual transgressions: – Practice a risk management approach (e.g., be aware of timing and the location of scheduled appointments, non-erotic touch, and general self-disclosure). – Be open to using supervision, consultation, and personal therapy throughout your career. © 2015. Cengage Learning. All rights reserved. Harmful Effects of Sexual Contact With Clients Clients who are the victims of sexual misconduct suffer dire consequences: – Distrust of the opposite sex – Distrust of therapists and the therapeutic process – Guilt, depression, anger, and/or PTSD – Feeling of rejection and low self-esteem – Suicidal ideation © 2015. Cengage Learning. All rights reserved. Legal Sanctions Against Sexual Violators Negative consequences for therapists include: – Being the target of a lawsuit – Being convicted of a felony – Having license revoked or suspended by state – Being expelled from professional organizations – Losing their insurance coverage – Losing their jobs © 2015. Cengage Learning. All rights reserved. Chapter 8 PROFESSIONAL COMPETENCE AND TRAINING © 2015. Cengage Learning. All rights reserved. Perspectives on Competence Professional codes of ethics on competence have common themes. Counselors practice only within the boundaries of competence, based on: – Education – Training – Supervised experience – State and national professional credentials – Appropriate professional experience © 2015. Cengage Learning. All rights reserved. Assessment of Competence Assessment approaches are most effective when they integrate both formative and summative evaluations. Formative assessment is a developmentally informed process that provides useful feedback during one’s training and throughout one’s professional career. © 2015. Cengage Learning. All rights reserved. Assessment of Competence Summative assessment is an end point evaluation typically completed at the end of a professional program or when applying for licensure status. © 2015. Cengage Learning. All rights reserved. Developing or Upgrading Skills Work with colleagues or professionals who have more experience. Seek consultation before moving outside areas in which you have received education and training. Learn new skills by attending conferences, reading professional articles, taking courses, and participating in workshops. © 2015. Cengage Learning. All rights reserved. Making Referrals You may need to refer a client if the resources are limited in the setting in which you work. – You may also need to refer a client if the boundaries of your professional role restrict you from delivering the services your client needs. © 2015. Cengage Learning. All rights reserved. Making Referrals Referring a client because of a conflict with your value system is not an ethically acceptable reason for a referral. Consider a referral as a final intervention after you have exhausted other interventions including consulting. © 2015. Cengage Learning. All rights reserved. Ethical Issues in Training Therapists Training programs have an ethical responsibility to: – Establish clear selection criteria – Provide exposure to major contemporary counseling theories – Teach students strengths and limitations of theories – Combine academic and personal learning © 2015. Cengage Learning. All rights reserved. Ethical Issues in Training Therapists Training programs have an ethical responsibility to: – Screen candidates to protect public from incompetent practitioners – Teach a range of skills to work with diverse clients – Provide training in ethics © 2015. Cengage Learning. All rights reserved. Evaluating Character and Psychological Fitness of Trainees Interpersonal behaviors of trainees have a direct bearing on their clinical effectiveness, so these factors must be taken into consideration in the evaluation process. © 2015. Cengage Learning. All rights reserved. Evaluating Character and Psychological Fitness of Trainees Character: – The honesty and integrity with which a person deals with others Psychological fitness: – The emotional or mental stability necessary to practice safely and effectively – Evidenced by the presence of personality adjustment, absence of psychological disorder, and appropriate use of substances © 2015. Cengage Learning. All rights reserved. Gatekeeper Role of Faculty in Promoting Competence The academic faculty in a professional program generally has a gatekeeper’s role, protecting consumers by identifying and intervening with graduate students who exhibit problematic behaviors. The gatekeeper role is addressed in the ethics codes of most professional organizations. © 2015. Cengage Learning. All rights reserved. Gatekeeper Role of Faculty in Promoting Competence When a student has good grades but demonstrates substandard interpersonal behavior, indicating serious unresolved conflicts, action needs to be taken. © 2015. Cengage Learning. All rights reserved. Gatekeeper Role of Faculty in Promoting Competence Well-designed gatekeeping procedures appear to improve the effectiveness with which deficient students are identified and prevented from progressing unremediated into the counseling profession. Dismissal from a program is a measure of last resort. © 2015. Cengage Learning. All rights reserved. Certification and Licensure Certification – Voluntary attempt by a group to promote professional identity – Attempts to verify qualifications – Sets minimum standards – Does not assure quality practice © 2015. Cengage Learning. All rights reserved. Certification and Licensure Licensure – Governs professional practice – Highlights uniqueness of an occupation – Restricts both use of title and practice of occupation © 2015. Cengage Learning. All rights reserved.
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Running head: DUAL RELATIONSHIPS

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Dual Relationships
Student’s Name
Course Number – Name of Course
University Name
Instructor’s Name
Date

DUAL RELATIONSHIPS

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Dual Relationships
The potential benefits of multiple relationships
Multiple relationships in psychotherapy occur in a situation when a therapist has more
than one role with one client such as a student, a friend or a close relative of the client (American
Psychological Association, 2018). There two arguments on multiple relationships. One set argues
that multiple relationships are ethical except for multiple sexual relationships while the other set
argues that all types of multiple relationships are unethical. There are many types of dual
relationships, and even though there are ethical concerns about them, not all of them are bad
(Zur, 2014). For example, a non-sexual dual relationship is not necessarily bad or illegal.
Instead, it has a lot of benefits which should not be overlooked. It is more likely to prevent
exploitation and sexual abuse rather than lead to it.
In some cases, a dual relationship is unavoidable and healthy. One of its potential benefits
is that it enables practitioners to increase their effectiveness in the settings where they work.
Practitioners who work in small communities need to interact and become an integral part of the
members so that they can be accepted because isolating themsel...


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