There are many difficult ethical decisions professionals in the field of psychology especially when in a therapist and or counseling position without crossing boundaries while avoiding dual relationships from forming. For example, a close friend of yours is having difficulty with her teenage daughter. She knows you are a psychologist who specializes in adolescents. She asks if you would be willing to see her daughter for a few sessions to straighten her out. Pope asks "What would each person consider the most ethical response?"The first problem given this scenario, there is already a dual relationship that is beginning because the therapist is a "close" friend of the client's mother. In this way you can try to compensate for some of the distortion that may occur from seeing things only from your own perspective" (Pope & Vasquez, 2007). Everyone has their own personal beliefs regarding professional ethics and boundaries they draw. It is very important to assess each situation differently especially when in the field of psychology regarding patient's confidentiality as well as following ethical codes as well as incorporating your personal ethics to ensure the most beneficial treatment.
Dual Relationships and Boundaries
When making ethical decisions the 14 standards should be reviewed and applied to the given situation before making any final decision. Professionalism can be difficult to maintain without breaking boundaries when faced with an ethical dilemma one is unsure of or unfamiliar with. However, there are alternatives that may be a better option regarding the case at hand. Counseling practitioners might ask themselves how they think about ethics. Although references are sometimes made to "the diversity standards" in the code of ethics, it would be a mistake to think that only the specific standards that use terms such as nondiscrimination and cultural diversity are pertinent to multicultural competence. As Remley and Herlihy stated, "With respect to cultural diversity, perhaps more than any other ethical issue, it is crucial that counselors attend to the spirit of the Code of Ethics" (Herlihy, 2006). A professional should always take one's cultural, spiritual, and religious background into consideration when making an ethical decision because one of those factors could play a major role in the decision making process in terms of how it will affect the client and possibly others. In this case, I strongly believe that this individual should see an "outsider" for many reasons despite how much of a talented therapist who concentrates on adolescents. The client's mother would have to be involved in some aspects because she is a minor which could be detrimental for treatment and due to the fact that it is very possible for the therapist and the girl's mother to converse. The Concept of Dual Relationships
Dual relationships exist when psychologist get involved with clients in any way that is beyond the role of the psychologist (Gleason, Shrout & Bolger, 2008). Such relationships might develop through socialization at a personal level with the client, accepting gifts or entering into business associations with clients. According to researcher’s ethical decision making is a process that is ongoing and has no simple answers. Psychologists need to find ways in which to advance the best interest of their clients and in order to do so need to manage their own life experiences and values with the code of ethics as they find ways in which to help their clients (Moleski & Kiselica, 2005). According to the American Psychological Association (APA, 2010) there has been major harm and exploitations as a result of dual relationships (Borys & Pope, 1989). The Ethical principles of psychologists require all psychologists to act in a manner that does not impair their professional judgment (Borys & Pope, 1989). Reamer (2001) states, in order for individuals to understand what dual relationships are they first need to understand the concepts of boundary crossing and boundary violation. There are five categories in which dual relationships fall into according to reamer (2001). The first category would be intimate relationships this would involve a sexual relationship between the psychologist and client. The second category would be personal benefits where the psychologist gets use to receiving gifts from the client. The third category would be emotional and dependency needs where the client becomes dependent on the psychologist. The fourth category would be altruistic gestures where the psychologists starts to perform favors and provides nonprofessional services. The fifth category is unanticipated circumstances which both client and psychologists have similar social groups that involve having the same friends (Reamer, 2001). Analyzing the Selected Scenario
The dual relationship presented is primarily between the therapist and the therapist’s friend. Though the therapist knows the daughter, the therapist may feel obligated to report to the mother. The therapist would be giving the daughter therapy sessions but ultimately would deal with both mother and daughter. The therapist will consult his or her friend’s daughter and a personal bond could have already been established prior to the first consultation. By the therapist consulting the daughter, his or her personal relationship is at risk. The therapy sessions may also be at risk. The friend might not be pleased by the way the therapist handles the sessions. The friend might also be discouraged that the therapist cannot discuss what is said during sessions and might be upset about what the therapist might learn from the sessions. This type of scenario is very difficult because there are several issues with these relationships.
First, this relationship can destroy “the professional nature of the therapeutic relationship” (Pope, 1995). The therapist knows the daughter and the friend and this can automatically cause the personal characteristics to intervene with the professionalism of the therapy sessions. Not only will the therapy be at risk but also the personal relationship. There is a bond between the therapist and the friend already that means that any personal concerns may influence the decisions that the therapist takes.
Second, this relationship may “create conflicts of interest and compromise the disinterest necessary for sound professional judgment.” (APA, 2010) Therapies may be compromised. The biggest concern comes in because “ethics are a set of principles concerning appropriate conduct for a group or individual (Corey, Corey, & Callanan, 1998)” (Qian, 2009). For example, the therapist may not ask all of the questions because he or she might feel obligated to tell the mother. The therapist might also avoid treatment that he or she knows the mother will not like. Decisions are embedded prior to getting the therapy. “Psychologists are aware that special safeguards may be necessary to protect the rights and welfare of persons or communities whose vulnerabilities impair autonomous decision making” (APA, 2010).
Third, “during or at any time thereafter the therapist may be compelled to offer testimony regarding the patient. This may include and may not be limited to patient's diagnosis, treatment, and prognosis.” (Pope, 1995) Because the therapist and mother are friends, the therapist might become a suspect. If there is any court order and the therapists need to testify and the judge also knows they are friends then this may put the therapist in a difficult position. According to Ethical Principles, “Psychologists recognize that fairness and justice entitle all persons to access to and benefit from the contributions of psychology and to equal quality in the processes, procedures, and services that are being conducted by psychologists. Psychologists exercise reasonable judgment and take precautions to ensure that their potential biases, the boundaries of their competence, and the limitations of their expertise do not lead to or condone unjust practices” (APA, 2010).
Last, the dual relationships can affect the cognitive processes and beneficial effects of therapy that maintain any benefits from the therapy. The therapist may not be giving the full therapy or may not follow therapy protocols because of his or her relationship. Also the patient may not take the therapist seriously because she knows that it is just her mother’s friend. The patient may not fully trust the therapist because she may not believe that the therapist will be confidential about what she tells her. There are several reasons how their dual-relationship may affect the therapy sessions. Ethical Issues in Dual Relationships
Ethical issues with reference to dual relationships are the most multifaceted and complicated in regards to the field of psychology. Dual relationships in respect to ethical standards are clearly prohibited. “Ethical Standards are very clear in stating that dual relationships which are reasonably likely to impair professional judgment or that leads to exploitation, are unethical” (Pelchat, 2000). The ethical issue presented within the selected scenario represents a situation where the psychologists is faced with determining whether or not she should take on the responsibility of counseling a close friends daughter. In my opinion, the most ethical decision would be for the psychologist not to see the friend’s daughter for a few sessions. In addition, it would be appropriate to refer her elsewhere, for instance maybe a colleague could better assist her due to their circumstances. It is my suggestion that it is best to avoid all dual relationships whenever possible, as you will less likely have problems you steer clear of them! Challenges by boundary issues in professional psychology
There are many challenges presented by boundary issues in professional psychology. We are all human and we all know right from wrong especially in field of psychology i.e. psychotherapy. Should you ever distribute personal information to a client? Should you ever offer free services to ones friends just like in our scenario? Have you ever done favors for clients? Or accepted gifts from a client? These so call actions appear to be innocent and harmless but they can bring about challenges to the professional/client relationship if they are altered in any way? The professional/client relationship is defined by boundaries. There are many challenges presented by boundary issues in professional psychology. "Boundaries are how the Self knows who it is and who it isn't. They determine not only where you end and you begin, but the space between us. Boundaries are central to how we make sense of life, how we deal with the dilemma of being human - the self-in-relation dilemma - which is to be close and connected to others and also to maintain our autonomy and independence (Adams, (2005))."Verbal boundaries deals with the concept of social space; for example, The example is the way that therapist know what they feel in order to answer the patients questions honestly, as opposed to giving answers which will satisfy the patients needs". "Behavioral boundaries deal with the fact of knowing when to stay and when to leave it deals with taking an action in one's own behalf". The psychotherapist who fails to recognize his own needs in the service of the client can run a great risk of becoming vicariously traumatized. "Nevertheless, it is solely your individual professional responsibility to maintain the boundaries. Therefore, the heart of ethical practice is taking responsibility for your actions, seeking the advice or consultation you need to restore the boundary appropriately, and, ultimately, continuing to learn and grow professionally as a result (Newman, (2007))." Conclusion
Remaining professional, following ethic codes as well as standards while facing many issues regarding boundaries is difficult, but absolutely necessary. Dual relationships are unhealthy between both parties and can defeat the purpose of therapy. Pope and Vasquez described an incident similar to our dilemma where a woman, Rosa seeks psychotherapy from her close friend June jeopardizing therapy. "She discusses them in detail with June, and by the end of the sixth session, June recognizes that an intense transference has developed. She encourages Rosa to consult another therapist but Rosa refuses, saying that there is no one else she could trust with these matters and that terminating the sessions would make her feel so betrayed and abandoned that she fears she would take her own life" (Pope & Vasquez, 2007). This is just one of the many dilemmas that arise that requires strong ethical decision skills that will be most beneficial in terms of the client's treatment. Given our scenario there is already a dual relationship on the cusp is developing which cannot be taken lightly. References
Adams, J. (2005). Work & Career. Retrieved from http://www.4therapy.com/consumer/life_topics/article/7967/484/Boundary+Issues American Psychological Association. (2010). Retrieved from http://apa.org. Borys, D. S., & Pope, K. S. (1989). Dual relationships between therapist and client: A national study of psychologists, psychiatrists, and social workers. Professional Psychology: Research and Practice, 20(5), 283-293. doi:10.1037/0735-7028.20.5.283 Gleason, M., Iida, M., Shrout, P., & Bolger, N. (2008). Receiving support as a mixed blessing: Evidence for dual effects of support on psychological outcomes. Journal of Personality and Social Psychology, 94(5), 824-838. doi:10.1037/0022-35188.8.131.524. Moleski, S. M., & Kiselica, M. S. (2005). Dual Relationships: A Continuum Ranging From the Destructive to the Therapeutic. Journal of Counseling & Development, 83(1), 3. Retrieved from EBSCOhost. Newman, C. (2007). Boundary Issues in the Professional/Client Relationship. Retrieved from http://ncaassociates.com/pdf/ICCA-1701-sa3-Newman.pdf Pope, Kenneth S.;