Boundary Issues and Dual Relationships
Determining boundaries and ethical relationships within the context of counseling is guided by the American Counseling Association (ACA) code of ethics. Ethical issues can be complex when dual relationships evolve during treatment. Utilizing criteria to avoid developing a harmful relationship and guide a professional and ethical practice is prudent to provide appropriate care. The professional needs to have guidance to evaluate outcomes for the client and access to professional guidance through professional associations and mentors. The code of ethics for your profession should be bookmarked on your computer.
Decision‐Making Model and Examples
To determine boundaries and ethical relationships the code of ethics is most valuable. The ACA’s (2014) code of ethics includes within the preamble, the foundation for ethical behavior and decision-making. This outlines the principles of professional ethical behavior including, autonomy, non-maleficence, beneficence, justice, fidelity, and veracity with in the profession. If, in the client interactions, these are not withheld or the client is not the center of the goals, then consideration for boundary-crossing should be evaluated. In 2014, the ACA Code of Ethics (Kaplan et al., 2017) adjusted the considerations around interaction to include Potentially Beneficial Interactions, but should be well documented and discussed for professionalism. Criteria used should be to evaluate the goals for the client and address if the goal is client-centered. In the interactions, is the conversation goal oriented, client driven and meaningful to the treatment plan? Does the cultural and ethical relationship remain objective? Are the principle’s of ethical behavior in the lead of the relationship? One example may include the dual relationship of a co-workers niece and the niece’s counselor. During a session a professional is made aware they work with the client’s aunt. The professional should disclose this information to the client, remind the client that privacy is key and that no disclosure of any information to the aunt. The professional should reflect upon the professional ethics and evaluate the ability to maintain autonomy and fidelity. Move forward by asking the client if they feel like the relationship would still provide therapeutic support for them or share other supports with in the community. Depending on the relationships it could be an easy decision or complex. If the relationship with Aunt is tenuous, there may be reason to have the client supported elsewhere. Maintaining the dignity of the client should be paramount. For physical attraction, the best would be to help the client find another counselor. If the professional is attracted to the client then the ability to be objective would be skewed. The intimate conversations that take place could lead to further temptations and would therefore diminish the therapeutic nature of the service provided. The ability to honor and fulfill one’s responsibilities of trust in professional relationships, may be diminished if the attraction continues.
Ethical Issues and Dimensions in Ethical Decision‐Making
Issues around terms of encountering former clients and the length and nature of the relationship may change after time. If we are talking years, and the client marries a family member that may be uncomfortable. During this situation the ability to clarify the nature of a professional relationship and how the shift to a family member may look. Boundaries still need to be discussed in private and the client may be the only one to share the relationship. In the terms of any relationship after the termination of services, it is prudent to evaluate personally how the relationship would impact the client. If negative impacts are noted, the relationship should be avoided if possible. Ethical dimensions that might change include the use of a professional-client services. The client should understand the relationship status and whether they are being served professionally (Dovidio, Sommers-Flanagan, Vietze, Sommers-Flanagan, & Jones, 2017). If the relationship is no longer the professional type, one ethical dimension that may change would be the outcome of the interactions. The relationship may take on a more personal and reciprocal nature, serving both individuals. One situation that may be boundary-crossing with a client would be over-sharing about a personal problem or dilemma. If the post-professional service relationship has developed in unanticipated ways, boundaries are clarified and relationship status is clear, an individual, who is a counselor, may choose to share more personal information than previous.
Development of Your Thinking about Ethics
The most important developments in my thinking of ethical practice is around developing criteria to use, based on professional associations and code of ethics to evaluate outcomes.
A basic rule that seems most relevant is around self-disclosure. Self-disclosure within a therapeutic relationship should serve the client’s outcomes (Kaplan et al., 2017). In the article entitled Managing risk when Contemplating Multiple Relationships, Younggren and Gottlieb (2004) offer these criteria:
1. Is entering into a relationship in addition to the professional one necessary, or should I avoid it?
2. Can the dual relationship potentially cause harm to the patient?
3. If harm seems unlikely or avoidable, would the additional relationship prove beneficial?
4. Is there a risk that the dual relationship could disrupt the therapeutic relationship?
5. Can I evaluate this matter objectively? (pp.256–57)
A Personal Reflection
In a small, rural town, having a dual relationship is not uncommon. In practice there are areas of growth around informed consent and communication that can guide professionals. Serving in youth ministry as well as a school nurse requires clear roles and responsibilities. While the perspective of a nurse is ingrained, it is valuable with youth to state with clarity, the role being served. In life-threatening situations the nurse duty will guide action. Guidance around spirituality is where the most difficult perspective is for these relationships. While the code of ethics of nursing encompasses the right to dignity, compassion and worth (Olson & Stokes, 2016), which can support spirituality, the role as youth leader and nurse vary in nuanced ways.
The ability to evaluate a relationship, define boundaries and assess outcomes for a client can lead to successful support. The dual-relationship boundary has developed into an acceptable outcome, if proper steps are taken to provide informed consent and the structure of the roles is clear. Avoiding these relationships is the very best, but at times can be unavoidable. Seeking guidance from professional associations, utilizing criteria to evaluate and developing boundaries will help a professional maintain therapeutic client-professional relationships.
References
Dovidio, J. F., Sommers-Flanagan, R., Vietze, D. L., Sommers-Flanagan, J., & Jones, J. M. (2017). Ethics and cultural diversity in mental health & wellness John Wiley & Sons, Inc.
Olson, L. L., & Stokes, F. (2016). The ANA code of ethics for nurses with interpretive statements: Resource for nursing regulation. Journal of Nursing Regulation, 7(2), 9-20. doi:10.1016/S2155-8256(16)31073-0
Kaplan, D. M., Francis, P. C., Hermann, M. A., Baca, J. V., Goodnough, G. E., Hodges, S., . . . Wade, M. E. (2017). New concepts in the 2014 ACA code of ethics. Journal of Counseling & Development, 95(1), 110-120. doi:10.1002/jcad.12122
Younggren, J. N., & Gottlieb, M. C. (2004). Managing risk when contemplating multiple relationships. Professional Psychology: Research and Practice, 35(3), 255-260. doi:10.1037/0735-7028.35.3.255