What are 4 types of multiple relationships?
- Non-professional relationship with client (friend, family member)
- Different professional relationship with the client (work colleague, tenant)
- Non-professional relationship with associated party (client’s best friend, sibling)
- Recipient of service provided by client (client is also your GP, psychologist, or masseuse etc.)
What are 3 problems associated with MRs?
- Unequal power relationship
- Conflict of interest
- Objectivity may be compromised
What’s the difference between boundary crossing and entering a MR with a client?
Boundary crossings become behaviours in a MR when the professional assumes another role in another relationship with the client
What are 3 examples of boundary crossing?
- Crying in front of a client
- Attending a client’s special event
- Disclosing a personal stressor to a client
If you were to enter into another relationship with a client, what are 3 things you should do before-hand?
- Be aware of client vulnerability and the potential for exploitation
- Conflict of interest - develop a plan to minimise harm
- Ensure your objectivity is not compromised
Give on example of how a boundary crossing can quickly turn into a boundary violation
Doing a home visit for an elderly person (acceptable boundary crossing), but then staying for dinner (boundary violation)
(Gottlieb and Younggren): What are the 4 strategies of ethical acculturation? Which is most likely to lead one down the slippery slope of boundary crossing?
- Integration (high maintenance of personal values, high contact/participation with new culture of psychology)
- Separation (high maintenance, low contact, more likely to make decisions based on personal values
- Assimilation (low maintenance, high contact)
- Marginalisation (low maintenance, low contact, most likely to go down slippery slope)
What were some of Gottlieb and Younggren’s recommendations for avoiding the slippery slope?
- Comprehensive informed consent document
- Peer consultation groups
- Document consultants’ suggestions
- Develop your own set of practice ethics policies
- More research
- Professional competence in multicultural context
What are the 9 steps Pope and Kieth-Spiegel (2008) recommend for considering whether a boundary crossing is helpful or harmful?
- Imagine the best and worst possible outcomes
- Look at the research
- Look at guidelines, ethics codes, laws
- Pay attention to your own feelings
- Inform the client about the exact kind of work you do. Refer on if client appears uncomfortable
- Refer on if you feel incompetent
- Put any planned boundary crossings in informed consent
- Keep notes
What are the 7 cognitive errors identified by Pope and Kieth-Spiegel (2008)
- What happens outside the session has nothing to do with therapy
- Crossing a boundary with a client is the same as doing that with a non-client (eg: helping them take off their coat)
- Our understanding of a boundary crossing is also the client’s understanding of a boundary crossing
- A boundary crossing that is therapeutic for one client will also be therapeutic for another
- A boundary crossing is a static, isolated event
- If we don’t see any downsides to crossing a boundary, then there aren’t any
- Self-disclosure is always therapeutic, because it shows authenticity, transparency, and trust
What are the 4 factors of Sonne’s model?
- Therapist factors
- Client factors
- Therapy relationship factors
- Other relationship factors
What are some therapist factors that may contribute to boundary crossings?
- Ethical sensitivity
- Willingness to expend cognitive effort
- Guiding ethical principles
- Gender - men tend to take more risks
- Culture
- Religion/spirituality
- Theoretical orientation (eg: humanists have more MRs)
- Character traits (eg: need to please)
What are some client factors that may contribute to boundary crossings?
- Gender
- Culture
- Religion/spirituality
- Psychosocial strengths/vulnerabilities (eg: not crossing boundaries with BPD clients)
- History of boundary crossings (eg: sexual assault victims)
What are some therapy-relationship factors that may contribute to boundary crossings?
- Nature of therapeutic relationship (eg: informed consent, transference)
- Power differential (greater = more risk to client)
- Duration of therapy
- Practice setting
- Practice locale (small/specialised communities at higher risk of MRs)
What are some other relationship factors that may contribute to boundary crossings?
- Change in nature of relationship
- Who’s needs are being met?
- Potential for role conflict/incompatibility
- Potential for harm to client/third parties
- Potential for client benefit
According to Sonne, what are 2 reasons for the inaccuracies in our thinking around nonsexual multiple relationships?
- The term ‘nonsexual multiple relationship’ is confused with incidental/accidental contacts, and boundary crossings
- The topic of nonsexual multiple relationships arouses uneasiness
What are some strategies for when multiple MRs cannot be avoided?
- Set clear boundaries
- Obtain informed consent
- Seek consultation, get more objective perspective
- Document practices
- Ask yourself whether the benefits of the MR outweigh the harms
- Self-monitor - who’s needs are being met by maintaining the MR?
According to Pope and Keith-Spiegel (2008), what are 9 steps you can implement if a boundary crossing goes wrong?
- Continue to monitor the situation carefully
- Be open and non-defensive
- Consult
- Listen to the client
- See it from the client’s point of view
- Look at research
- Keep records
- Consider apologising
- Apologise if need be
What are 3 work settings that have a higher incidence of boundary crossings?
- Individual practice
- Home offices
- Practices in small (eg: rural or ethnic) communities
- Consulting to organisations
What’s the main problem with going into business with current or former clients?
Conflict of interest
What’s the main problem with providing psychological services to family and friends?
Objectivity is compromised
What are the 3 most commonly requested secrets from clients in couples therapy?
- Extra-relational affair
- Wanting a divorce
- Internet infidelity/chatting
What are some challenging ethical issues that arise when working with families?
- Treating the entire family if one member does not want to participate
- Inconsistent training and qualifications of family therapists
- Seeing one family member without the others present
- Informing clients of values implicit in the mode of therapy
- Dealing with requests for information from family members
- Sharing values with clients
- Manipulating a family for therapeutic reasons
- Obtaining the informed consent of children
- Preserving the family
