Tag Archives: Boundaries

Slippery Slopes and Dual Relationships


In debate or rhetoric, a “slippery slope” argument is known as an informal fallacy.  The argument suggests that a relatively small first step inevitably leads to a chain of related events culminating in some (generally undesirable) significant impact, in this case, a severe boundary violation.  (Fischer, 1970)  “The mere existence of a multiple relationship does not, in itself, constitute malpractice; rather, it is misusing power, harming, or exploiting a client that is unethical.”  (Corey, Schneider-Corey, & Callanan, 2007, p. 269)  The suggestion that the mere existence of a dual relationship leads to severe boundary violations is an unsubstantiated causal relationship.  However, the correlation is made because severe boundary violations can and do happen, and inevitably they can coexist with multiple relationships.

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Every therapist can probably relate to having friends that talk about their problems.  I already play that informal role with a number of my friends and family (e.g. confidant, advisor).  Generally speaking, it is probably fair to say that I should not engage in professional therapeutic relationships with these friends or family members.  The definition of “formal” is one with a good deal of ambiguity however… I would be inclined to define it as “anyone who pays for my services or comes to the office for the visit.”  I anticipate I will have difficulty “shutting down” my therapeutic mind when placed in that informal role.  Within that context, there is potential for a bit of a “slippery slope.”

Another possible dual role I can anticipate is that of a court appointed evaluator.  In this situation, once I have assumed that role (with the court as my client) I cannot then assume a role as a therapist for the same client.  In that situation, I will likely need to refer the client to another primary therapist.

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References

Corey, G., Schneider-Corey, M., & Callanan, P. (2007). Issues and ethics in the helping professions (8th ed.). Belmont, CA: Brooks/Cole.

Fischer, D. H. (1970). Historians’ fallacies: Toward a logic of historical thought. New York, NY: Harper & Row.

 

Dual Relationships in Rural Areas


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Having grown up in small north-central Iowa town (population 2400), I can totally identify with the Nickel premise that extra-therapeutic contact “is not only unavoidable at times, but, under certain conditions, even uniquely beneficial.”  (Nickel, 2004, p. 17)  Smaller communities are indeed more interdependent, inevitably leading to situations where there are simultaneous overlapping relationships.  In a town the size of Eagle Grove it is a foregone conclusion that if you work with anyone in the community, you know most if not all of the significant others in that person’s life.  We used to joke that it was “unusual if a neighbor didn’t take note of what color underwear you were wearing today.”  The reality is that the closest hospital, or referral source for mental health treatment, would be 30 miles away.  That’s an insurmountable distance for some people who need access to local mental health facilities.

I wholeheartedly agree with the statement that “rural culture often upholds the prevailing notions that outsiders are not to be trusted, and that a community should care for its own.  (Nickel, 2004, p. 19)  I submit that it would be extremely difficult to a therapist to be successful in the absence of such multiple relationships, because it is those relationships that foster the foundation of the working relationship needed to make lasting progress in a mental health setting.  In any case, there are systemic risk assessments that should likely be engaged in.  “Age, diagnosis, life experiences such as abuse, and culture are key elements that need to be considered in establishing boundaries.”  (Corey, Schneider-Corey, & Callanan, 2007, p. 282)

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References

Corey, G., Schneider-Corey, M., & Callanan, P. (2007). Issues and ethics in the helping professions (8th ed.). Belmont, CA: Brooks/Cole.

Nickel, M. (2004). Professional boundaries: The dilemma of dual & multiple relationships in rural clinical practice. Counseling and Clinical Psychology Journal, 1(1), 17-22. Retrieved from http://web.ebscohost.com.ezproxy.bellevue.edu/ehost/pdfviewer/pdfviewer?vid=2&hid=17&sid=1c482e9f-e9cf-44cc-a08d-39a86f74b8f3@sessionmgr10

Client Crushes


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I think crushes on therapists happen a lot more than we actually realize.  It’s so common that Sigmund Freud coined the term “transference” to describe it.    Transference likely occurs in this context because clients are only exposed to the “ideal image” of a counselor.  The therapeutic environment is generally safe and supportive, and within that context, the clinician can be seen as a “provider.”  Within that environment, clients usually engage in what is likely one of the most intimate relationships clients will ever have… clients often tell clinicians things they wouldn’t tell anyone else!  Isn’t our job to be caring, responsive, thoughtful, and generally concerned for our clients?  Unfortunately, we reside in a world that is anything but that.

What are the signs of a client that a client has a crush?  Signs might include a client wearing suddenly provocative or revealing attire.  A client may compare the therapist to people in their own lives, like a spouse or a parent.  The client may verbalize expressions of love or adoration, or the same may manifest in the form of unexpected gifts.  The client may start asking more personal questions, like what the therapist likes to do, movies that they like, etc.  They may also ask questions about your relationships, your marital status, your children and their ages.

It is probably one of the more awkward positions for a therapist to be in.  If a client finds themselves attracted to a clinician, I would definitely encourage them to convey that to the therapist.  Having a client reveal their innermost feelings and ideas is at the core of psychotherapy.  Unfortunately, the client themselves is short-changing themselves if they don’t reveal the “crush.”  This is especially true if a client is intentionally hiding “undesirable traits or feelings” in effort to gain favor or “appear more normal” for the therapist.  It’s certainly not anything to be ashamed of.  Despite the fact that we are prone to be adored, I think we really need to keep a level head about the whole situation… in reality, if our clients really “knew” us; we probably wouldn’t be so attractive.  I can see how it would be easy for a therapist to be delusional with all this envy going around.

How would I respond?  In the case of an inexperienced clinician, there is good potential for those feelings to “get in the middle” of the client-counselor relationship.  As a result, a referral might be in order if the client has repeatedly crossed boundaries (like repeatedly calling the therapist at home during odd hours, or showing up at their residence unannounced, etc).  However, I would consider a referral as a less than ideal situation.  Ideally, a client’s feelings for a counselor can be employed and explored to help the client understand a great deal more about themselves.  If we can drive to the source of that transference in a professional manner, perhaps that can be utilized as a choice opportunity to advance our client’s best interest.

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