Section 8

Question 1

On what grounds are psychologists most frequently disciplined?

S8: A
p 541

Answer 1

Boundary violations

Question 2

Who was responsible for introducting the concept ot role boundaries into professional ethics and why

S8: A
p 541

Answer 2

By: feminist scholars

Why: they were upset at the (mostly sexual) exploitation of (mostly female) clients by (mostly male) professionals

Question 3

What balance do psychologists try to strike in maintaining health boundaries with clients?

S8: A
p 541

Answer 3

Protecting personal autonomy and facilitating personal engagement
(find professional stance between under involvement and over involvement)

Question 4

Why are boundaries so important to professional ethics?

S8: A
p 542

Answer 4

Because of the inherent power imbalance in our relationships with our clients

Question 5

Instead of just avoiding dual relationships, psychologists are advised to avoid _____ dual relationships

S8: A
p 542

Answer 5

Harmful dual relationships

Sometimes dual relationships are unavoidable, e.g. rural communities

Question 6

Which parts of the Code of Ethics provides guidance on dual relationships?

S8: A
p 543

Answer 6

Principle iii: Integrity in relationships

• do not exploit relationships established as a psychologists for personal, political, business gain
• avoid multiple/dual relationships

Integrity helps us to avoid being lustful, greedy, vain, etc (using relationship for wrong reasons)

Question 7

Speak to the ethical conflict with allowing a client barter for service (provide something other than the professional fee in payment) (dual relationships)

S8: A
p 544

Answer 7

• can be problematic because you may then become that client’s employer (e.g. if client offers carpentry services in exchange for psychotherapy) –> power imbalance
• can easily lead to feelings of betrayal if either party becomes unhappy with arrangement

Question 8

Speak to the ethical conflict with giving and receiving gifts (dual relationships)

S8: A
p 544

Answer 8

• may change the role expectations of the professional relationship

You give a gift: client may feel pressured to reciprocare to avoid getting inferior care

Client gives gift: you may feel need to reciprocate by giving “special care”

• be sensitive to cultural nuances here

Question 9

Speak to the ethical conflicts that may arise in rural practice (dual relationships)

S8: A
p 545

Answer 9

urban psychologists - much less likely to have challenges with dual relationships

rural - turning away clients can result in financial hardship for you and can be harmful to client (limited access to service)

Must weight potential harm of turning client away against potential harm arising out of dual relationship

Recommended: rural psychologists develop generous capacity for tolerating ambiguity in relationships, use good consent forms, and lean towards providing brief/less intense services where appropriate

Question 10

Speak to the ethical conflicts that may arise in providing forensic services (dual relationships)

S8: A
p 545

Answer 10

The LEGAL system often becomes the client, not the person involves

Occurs when psychologists are asked to provide consultations on child custody cases, parole decisions, etc

Question 11

Speak to the ethical conflicts that may arise in providing teaching and supervision (dual relationships)

S8: A
p 546

Answer 11

Professors-student relationships can be complex dual relationships, can have risk for exploitation due to power imbalance in relationship (2 - 15 % of students have engaged in sexual relationships with professors, decreasing)

Supervision can be complex with facilitator/supporter role conflicts with evaluative role

Question 12

What are some of the ways you can deter your client from thinking you are open to a sexual relationship?

S8: A
p 550

Answer 12

• clarify cultural norms around personal space, etc
• do not ask about client’s sexual history unless it is directly relevant to the case
• respond with brief “thank you” to compliments, move on and do not reciprocate
• do not answer questions about your own sexuality

Question 13

What factors should you consider when deciding if you should or shouldn’t accept a client’s gift?

S8: C

Answer 13

• the monetary value (no no to lavish gifts)
• what the clinical implications might be if accepting/declining
• when in the therapy process were you offered the gift (much more damaging/risky at beginning)
• what are YOUR motivations for acceping/declining gift
• are there relevant cultural implications

Question 14

When might it be okay to accept a gift from a client?
S8:C
p 563

Answer 14

• small, inexpensive
• culturally appropriate
• at the end of therapy

Question 15

T or F: Touching clients should generally be avoided

S8: C
p. 565

Answer 15

False: nonerotic touching is often appropriate and can have significant therapeutic value; of course - do with discretion depending on client and nature of relationships

Question 16

Compare and contrast boundary cross vs boundary violation

S8: E
p. 573

Answer 16

Boundary crossing: departure from common practice that could potentially benefit the client (e.g. pat on shoulder)

Boundary violation: serious breach that results in harm to client; unethical e.g. sex with client

Question 17

What the the phrase “avoid the slippery slope” mean and why is it important?

S8: E
p. 573

Answer 17

A gradual erosion of boundaries that can lead to problematic multiple relationships that bring harm to clients
–> happens when boundaries are poorly defined and when therapists allow role to blend

Important because one or two sloppy boundaries can lead to progressive deterioration of boundaries, causing harm to client

Question 18

How does one “avoid the slippery slope”? (2 ways)

S8: E
p. 573

Answer 18

1. Have a therapeutic rationale for crossing the boundary

2. Question behaviors that are inconsistent with theoretical approach/code of ethics

Question 19

What are some questions you could ask yourself if you are having difficulty maintaining appropriate boundaries with your client?

S8: F
p.577

Answer 19

• IS THIS IN THE BEST INTEREST OF MY CLIENT?
• who’s needs are being served
• will this impact my quality of service
• how would the client’s family view this?
• how would a colleague view this?
• am i treating this client differently from other clients?
• does this client mean something ‘special’ to me?
• can I put this in my client’s file

Question 20

List a few reasons why sexual multiple relationships should be avoided? (impact on client)

S8: H
p.582

Oberlander and Barnett

Answer 20

Abuse of trust

Misuse of power

Harm

Exploitation

Question 21

What are some of the ‘slipppery slope boundaries’?
(one should be conscious of how they interact with client’s on these factors to avoid ethical violations)

S8: H
p.583

Oberlander and Barnett

Answer 21

role
time
space
touch
self-disclosure
gifts
physical contact

Question 22

Why are nonsexual multiple relationships acceptable between faculty and students?

S8: H
p.584

Answer 22

Because this allows faculty to serve as
guides
role models
teachers
sponsors
helps student access opportunities for career and P.D

Question 23

Describe the Decision Making Model for Graduate Assistants (dual relationships)

S8: H
p.587

Answer 23

1. Is the dual relationship NECESSARY
2. Is the dual relationships EXPLOITATIVE
3. Who does the dual relationships BENEFIT
4. Is there RISK that dual relationship could HARM STUDENT
5. Could dual relationship DISRUPT EDUCATIONAL relationship
6. Is evaluation of dual relationships OBJECTIVE
7. Have you DOCUMENTED decision-making process
8. Did student give INFORMED CONSENT to risks of dual relationships

Question 24

What are some strategies you can use to avoid dual relationships with students as a GA/TA/etc?

S8: H
p.590

Answer 24

1. Recognize your position of power of students
2. Recognize vulnerability of psych students (we’re all a bit nuts)
3. Limit social contact with students; keep it professional
4. Be aware of continuum of multiple relationships (not all are harmful)
5. Be aware of resources of report sexual harassment
6. Consult
7. Be vigilant of emotional distress such as isolation (in self and others)
8. Acknowledge power/responsibility of having a faculty role
9. Develop process for evaluating student-faculty relationships
10. Foster climate for ethical relationships

Question 25

Speak to the difficulty/complexity of treating clients who have been sexually abused by a previous therapist S8: J p. 599

Answer 25

Treating these clients tends to be exceptionally difficult and complex.

Question 26

T or F: Psychiatrist engage in more sexual dual relationships with patients than psychologists, social workers S8: J p. 600

Answer 26

F - no significant difference between the three BUT Marriage and Family Counsellors are far more likely to do so

Question 27

In what ways could the research on the impacts of sexual dual relationships on client be skewed? S8: J p. 601

Answer 27

Some say that only those who have been harmed by dual sexual relationship would come forward to participate in research; those who may not have been harmed or who benefited may not come forward to participate in studies Much we will never know about impact of sexual victimization of clients (difficult to study)

Question 28

What are some of the symptoms of Therapist-Patient Sex Syndrome? S8: J p. 601

Answer 28

``` ambivalence guilt emptiness/isolation sexual confusion impaired ability to trust identify/boundary confusion emotional lability (undergoing change) pressured rage increased suicidal risk cognitive dysfunction ```

Question 29

What are some of the common reactions that therapists may have when they find out their client has been sexually exploited by a therapist? S8: J p. 603+

Answer 29

1. Denial and disbelief (question credibility of story; protecting profession 2. Minimization of harm (based on cultural tendency to minimize victimization of women) 3. Making patient fit textbook (not sure p 610) 4. Blaming the victim (they had a role in it) 5. Sexual reaction to the victim (aroused by victim) 6. Resentment/discomfort at lack of privacy (if victim decided to file a complaint) 7. Difficulty keeping the secret 8. Intrusive advocacy (trying to convince client to report/not report perpetrator) 9. Vicarious helplessness (difficulty managing own symptoms of distress) 10. Becoming object of rage, neediness and ambivalence (transference for client's anger/depression)

Question 30

Describe some of the impacts/belief clients may have about being sexually victimized? S8: J p. 610

Answer 30

- remain in long period of shock - numbing of cognitive/affective reactions - severe boundary disturbance - may be convinced that perpetrating therapist could read their mind - may believe that abuse was legitimate/useful to therapy; that therapist was genuinely caring for them (analogous to battered wive syndrome) - ambivalence (clinging/worshiping abuser AND fearing/despising abuser) - may experience deep, chronic, shame

Question 31

What are the two most commonly held beliefs by perpetrators (therapists) of sexual abuse regarding the dual relationship? S8: J p. 610

Answer 31

1. The victim was not genuinely harmed | 2. The victim was not a vulnerable individual (actually the instigator or at least a willing participant)

Question 32

How does the therapeutic relationships change if your patient, a victim of therapist-client sexual abuse, decides to file a complaint? S8: J p. 613

Answer 32

conversations in therapy continue despite: - the fact that they may not be confidential - chart notes could be subpoenaed - therapist may be deposed/cross examined - may be blamed for client's current symptoms due to your 'incompetence'

Question 33

What are the three major types of sexually abusive therapists? List some of the subtypes S8: J p. 610

Answer 33

1. Power and Control Sexual preoccupation (focused on sex) Substitution (patient fulfills another role for therapist) Attraction to pathology (e.g. attracted to narcissism) Authoritarian orientation (wants power over dependent) Physical immobilization (attracted to people who can't move) 2. Anger Battering (feels justified in hitting patient) Emotional abuse (feels justified in screaming at patient) Provoking Decompensation ( encourages client to perform activities that will harm them e.g. drugs) 3. Sadism Pleasure in causing pain to patient Sexual humiliation

Question 34

Why should the dual relationships that graduate student experience be given more attention? Oberlander and Barnett p. 582

Answer 34

lessons learned during one's grad school experience about appropriate maintenance of boundaries and how to ethically manage multiple roles/relationships will likely significantly impact one's future conduct