Client’s Rights, Confidentiality, and Ethics
11/13/12
Andrea Schneider
A very serious and difficult matter in the counseling profession is the issue of multiple
relationships, boundary crossing, and boundary violation. Many times, it is impossible for the
counselor to avoid a multiple relationship or boundary crossing, but a counselor should always
avoid a boundary violation. Multiple relationships occur when professionals assume two or
more rolls at the same time or sequentially with a client. A boundary crossing is a departure
from commonly accepted practices that could potentially benefit clients; however, a boundary
violation is a serious breach that results in harm to clients and is therefore unethical (Corey,
Corey, & Callanan, 2011).
A good example of a multiple relationship is when the client is also a student, friend,
family member, employee or business associate of the therapist. Voluntary-avoidable: Usually
these dual relationships take place in large cities or metropolitan areas where there are many
therapists, many places to shop, worship or recreate. According to Zur Institute, there are
different types of dual relationships. There are unavoidable dual relationships; these
relationships are often found in isolated rural areas, small minority groups, disabled groups or
spiritual communities, on the Native American reservations, or any small community in big
metropolitan areas and training institutions. They are also often unavoidable in sports
psychology and spiritual counseling. Supervisory relationships inherently involve multiple
relationships as part of the triangle of supervisor-supervisee-client. Mandated dual relationships
take place in the military, prisons and in some police department settings. Occasionally there are
unexpected multiple relationships. These relationships occur when a therapist is not initially
aware that the client they have been working with is also a friend, colleague, co-worker or even
an ex-spouse of another client. Similarly, unexpected dual relationships take place when,
unbeknownst to the psychotherapist, the client joins the therapist’s church, book club, or baseball
recreation league (Zur, 2011). The mere existence of a multiple relationship does not, in itself,
constitute malpractice; rather, it is misusing power, harming, or exploiting a client that is
unethical (Corey, Corey, & Callanan, 2011).
Boundary crossing is a different matter. Boundary crossing occurs when the counselor
departs from the verbal and physical distances normally maintained in a counseling interaction
(Stone, 2011). Boundary crossing isn’t necessarily unethical or wrong; as long as the boundary
crossing is in the best interest of the client, and they aren’t being harmed in any way. There are
some helpful guidelines that a counselor should consider when boundaries are being crossed.
The counselor should be motivated by what the client needs rather than by his or her own needs.
The boundary crossing should be consistent with a client’s treatment plan. The client’s history,
culture, values, and diagnosis should have been considered. The rationale for the boundary
crossing should be documented in the client’s record. The boundary crossing should be
discussed with the client in advance to prevent misunderstandings. Full recognition should be
given to the power differential, and the client’s trust should be safeguarded. The counselor
should consult with colleagues to help guide the decision (Corey, Corey, & Callanan, 2011).
Multiple relationships and boundary crossings aren’t necessarily unethical or harmful to
the client, but boundary violations are. While the most widely discussed boundary violation is
sexual relations between the counselor and the client, nonsexual boundary violations are
common as well. These may include such phenomena as soliciting donations from one's client,
entering into a business transaction with one's client, excessive self-disclosure of the counselor's
personal problems, and breaking the client's confidentiality (Gabbard, 2005). If a counselor’s
actions result in harm to a client, it is a boundary violation. Failing to practice in accordance
with prevailing community standards, as well as other variables such as the role of the client’s
diagnosis, history, values, and culture, can result in a well-intentioned action being perceived as
a boundary violation (Corey, Corey, & Callanan, 2011).
Maintaining proper boundaries with clients can be difficult. The counselor must be
careful with the boundaries of physical touch, bartering for services, receiving or giving gifts,
and having any sort of friendship with a client. In each of these cases there is the possibility of
the gesture to help or harm the client. Intentional boundary crossings should be implemented
with two things in mind: the welfare of the client and therapeutic effectiveness. Boundary
crossing, like any other intervention, should be part of a well-constructed and clearly articulated
treatment plan which takes into consideration the client's problem, personality, situation, history,
culture, etc. and the therapeutic setting and context. Dual relationships, since they always entail
boundary crossing, impose the same criteria on the therapist. Even when such relationships are
unplanned and unavoidable, the welfare of the client and clinical effectiveness will always be the
paramount concern (Zur, 2011).
It is necessary for counselors to establish and maintain appropriate boundaries. However,
maintaining professional boundaries should not be construed as a call for rigidity. Indeed, a
flexible analytic frame is necessary to respond to patients with varying needs, conflicts, and
deficits. The elasticity of the frame reflects not only the patient's specific needs, of course, but
also the analyst's subjectivity (Gabbard, 2005). Establishing safe, reliable, and useful boundaries
is one of the most fundamental responsibilities of the therapist. The boundaries must create a
context in which therapist and patient can do the work of therapy.
Works Cited:
Corey, Corey, Callanan. (2011, 2007). Issues and ethics in the helping professions. Belmont, CA:
Brooks/Cole.
Gabbard, G. (2005). Boundary violations. Retrieved from
http://www.answers.com/topic/boundary-violations
Stone, C. (2011, 07 11). Boundary crossing: the slippery slope. Retrieved from
http://www.ascaschoolcounselor.org/article_content.asp?article=1221
Williams, M. (1997). Boundary violations. Retrieved from
http://www.williamspsychologicalservices.com/SAdocs/bv.html
Zur, O. (2011). Innovative resources and online continuing education. Retrieved from
http://www.zurinstitute.com/dualrelationships.html
Reflection Paper General Instructions and Rubric
Purpose: As a professional Substance Abuse Counselor, potential employers will expect you to be able
to apply the knowledge, attitudes, and critical thinking skills, which demonstrate an understanding of
the complexity of managing professional and ethical boundaries with clients and dual relationships in
your practice as an ethical counselor. One way of achieving this is to produce a well-written and
thoughtful response to important questions and issues facing both you as an individual counselor,
counseling agencies, clients, and society as a whole. Therefore, you will be asked on several occasions in
this course to develop reflective responses on various topics.
Format: All reflection paper should be 3-4 pages long, computer generated, double-spaced and in a 12
point regular font with one-inch margins. Despite the fact that these paper are designed to reflect your
thinking process, they must cite external sources as these will help you to develop an informed opinion
based on facts and not biases. Thus, each reflection paper must include a reference page (bibliography)
of no less than five sources. These sources must be legitimate, reputable and fully referenced (i.e. no
wikipedia and no blogs). You are to use APA citation style. Grammar and spelling will count. Do not
procrastinate and try to write your reflection papers at the last minute. These reflection papers are to
demonstrate your understanding and engagement with the topic and must be thoughtful and
meaningful.
Grading Rubric: The following rubric will be used to evaluate your work.
Reflection Paper
Rubric
Exceeds Standards
Meets Standards
Unsatisfactory
5 points
4 points
3-0 points
Format
Paper is neatly typed,
double-spaced, 10-12
point regular font, oneinch margins, and 3-4
pages in length with a
minimum of five
references.
Paper is neatly typed,
double-spaced, 10-12
point regular font, oneinch margins and 2.5-3
pages in length or short
one reference.
Formatting rules ignored,
shorter than 2.5 pages or
missing more than one
reference.
Grammar and
Spelling
No errors.
1-2 minor errors.
Lacks basic proofreading
or contains major errors.
Organization
Well-organized, well
written, easy to read and
understand.
Well-organized but “flow”
could be improved.
Organization lacking and
arguments difficult or
impossible to follow.
Submission
On time with no
resubmissions.
Resubmission for more
points.
Late or several
resubmissions.
Reflection
Shows strong evidence of
reasoned reflection and
depth.
Shows evidence of
reasoned reflection.
Lacks reflection and
depth.
Connection to
readings
(assigned and
ones you have
sought on your
own)
In-depth synthesis of
thoughtfully selected
aspects of readings
related to the topic.
Makes clear connections
between what is learned
from readings and the
topic. Demonstrate
further analysis and
insight resulting from
what you have learned
from reading. Includes
reference to at least two
readings other than those
Goes into more detail
explaining some specific
ideas or issues from
readings related to the
topic. Makes general
connections between
what is learned from
readings and the topic.
Includes reference to at
least one reading other
than those assigned for
class.
Identify some general
ideas or issues from
readings related to the
topic. Readings are only
those assigned for the
topic or there is little
evidence that required
readings were read.
Score
assigned for class.
Connection to
class discussions
& course
objectives
Synthesize, analyze and
evaluate thoughtfully
selected aspects of ideas
or issues from the class
discussion as they relate
to this topic.
Synthesize clearly some
directly appropriate ideas
or issues from the class
discussion as they relate
to this topic.
Restate some general
ideas or issues from the
class discussion as they
relate to this topic or
does not incorporate
ideas from discussion.
Arguments
Provides excellent
support for claims.
Provides support for
claims.
Relies solely on opinions
or inappropriate sources.
Original work
Work clearly that of the
author and all citations
appropriate and properly
referenced.
Work that of the author
but relies heavily on cited
sources.
Work relies almost
exclusively on work of
others.
Completeness
Addresses all elements
contained within the
stated objective(s) of
assignment and extends
beyond.
Addresses all elements
contained within the
stated objective(s) of
assignment.
Fails to address all the
elements contained
within the stated
objective(s) of
assignment.
Total