Tag Archives: Boundary Issues

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.

 

Gifts, Therapy, and Actions @ “The Boundary”


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In my opinion, gift giving within the context of the therapeutic relationship is an exercise in common sense.  None of the ethics codes specifically declare gift exchange as unethical, although it can certainly be unethical if taken to extremes.  I view “appropriate” gift giving as a tool to show appreciation and to advance the therapeutic alliance.  In his analysis of the “spectrum of boundary interventions,” Glass (2003) suggested we use the neutral term “actions at the boundary” instead of “boundary violation or transgression,” thereby designating that no boundary was crossed.  The most appropriate gifts in my opinion are “symbolic” and relatively inexpensive, although I can certainly see situations where even inexpensive gifts are wholly inappropriate (especially if they have sexual connotations).  If I was to give a gift, I would probably lean toward therapy-related educational materials (books, etc).

If presented with a gift, I would likely accept it depending on the situation.  I would take the size and the content of the gift into consideration, never accepting gifts that are too expensive, personal, or provocative.  I would also examine the kind of patient presenting the gift, and make as assessment as to whether they would benefit from its acceptance.  I would also be very cognizant of the context… is it early in treatment, around the holidays, or at the time of termination?  The dynamic meaning of the gift is also a consideration, although it is beyond the scope of this essay.  I would guide the interested reader to the Smolar (2002) article for in depth analysis of dynamic meanings of gifts.

In the case of a child giving a hand-made gift, I would generally speaking accept it and proudly display it.  If it advances the therapeutic alliance, I am all for it!

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References

Glass, L. L. (2003). The gray areas of boundary crossings and violations. American Journal of Psychotherapy, 57(4), 429-444. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=525045091&sid=3&Fmt=4&clientId=4683&RQT=309&VName=PQD

Smolar, A. I. (2002). Reflections on gifts in the therapeutic setting: The gift from patient to therapist. American Journal of Psychotherapy, 56(1), 27-45. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=115179463&sid=3&Fmt=3&clientId=4683&RQT=309&VName=PQD