Why Is the Initial Consultation so Important? What Factors Will an Ethical Therapist Cover at This Time?

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Why is the initial consultation so important? What factors will an ethical therapist cover at this time?

There are a multitude of factors that a therapist must consider during the initial consultation. I will describe the actual mechanics of the consultation, the ethical considerations facing the therapist and the particular challenges of the actual consultation itself.

Before even meeting the client, it is vitally important to consider the role of the environment in the therapeutic space. Consequently, there are a number of aspects of the room itself that need to be looked at. The layout of the room should be considered. The generally accepted approach is to have 2 upright chairs facing each other at an angle for the consultation and talking therapies, along with a recliner for hypnotherapy.

We also need to look at the other environmental factors, such as the colour of the room, whether the room is in a noisy or a quiet area and whether or not to play music. We also need to consider how we dress and even how the room smells.

There are a number of ethical factors to be considered.

Dual Relationship:

Where the therapist already has a relationship with the client outside of the consulting room, especially on a personal basis.

Dual roles defined

The American Psychological Association (2002, p. 1065) Ethical Standard 3.05 (Multiple Relationships) states the following: (a) A multiple relationship occurs when a psychologist is in a professional role with a person and (1) at the same time is in another role with the same person, (2) at the same time is in a relationship with a person closely associated with or related to the person with whom they have the professional relationship, or (3) promises to enter into another relationship in the future with the person or a person associated with or related to the person.

A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist’s objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists.

Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.

(b) If a psychologist finds that, due to unforeseen factors, a potentially harmful multiple relationship has arisen, the psychologist takes reasonable steps to resolve it with due regard for the best interests of the affected person and maximal compliance with the Ethics Code.

(c) When psychologists are required by law, institutional policy, or extraordinary circumstances to serve in more than one role in judicial or administrative proceedings, at the outset they clarify role expectations and the extent of confidentiality and thereafter as changes occur. (See also Standards 3.04, Avoiding Harm, and 3.07, Third-Party Requests for Services.)

Sexual Attraction. If the therapist is sexually attracted to their client, it can lead to poor or self-serving advice or even an abuse of the position of trust that is absolutely vital to the therapist. Research has shown the extent of the damage and harm that can be done if the therapist acts upon their sexual attraction to their client. Basing her analysis on an original study and a review of previous research (such as Belote, 1974; Chesler, 1972; Dahlberg, 1971; Taylor & Wagner, 1976), Durre (1980) concluded that:

"amatory and sexual interaction between client and therapist dooms the potential for successful therapy and is detrimental if not devastating to the client" Dr Lindda Durre’s research cited "many instances of suicide attempts, severe depressions (some lasting months), mental hospitalisations, shock treatment, and separations or divorces from husbands. . . . Women reported being fired from or having to...
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