Common and Not-So-Common Ethical Considerations

Course excerpt from Ethics & Boundaries in Psychotherapy

In the everyday practice of psychotherapy, professional therapists may regularly expect to encounter a number of ethical dilemmas, some of them commonplace and routine, others more exotic and challenging. Among the challenges that have come about more recently are the ethics and boundary issue that accompany the use of social media. Psychotherapists probably make numerous ethical decisions every day, frequently without any awareness they are doing so. With years of experience, such decisions may become reflexive responses, requiring little – if any – deliberation.

Examples of these “garden variety” ethical issues may be questions like these:

  • You want to present your client with the opportunity to give informed consent for the treatment you are about to deliver. How do you assure that you include all of the relevant issues, and that the client understands and is competent to give such consent?
  • A grateful client brings you a gift. Do you accept it and thank her, do you explain that you do not accept gifts from clients, or do you choose some other ethical course of action?
  • You encounter a client in a social situation. In consideration of his right to privacy and confidentiality, do you approach him in a friendly manner or do you wait for him to take (or not take) the initiative?
  • You receive an invitation on your professional LinkedIn page from a current client who has googled you and wishes to communicate via this medium. Does a digital connection constitute an inappropriate multiple relationship?
  • You find that the husband in a couple you have been treating in marital therapy is the new minister in your church. Do you find another church, discontinue therapy with the couple, or consider some other course of action?
  • You have a client who is moving out of the state, and she asks you to continue treating her via Skype sessions until she can connect with a new therapist. What are the ethical ramifications of engaging in teletherapy?
  • A client tells you in a therapy session that another therapist in town has become socially involved with your client’s friend, whom that therapist was recently treating. Do you report this activity to the state licensing board, confront the other therapist, or choose some other course of action?

Of course, even the most mundane situations can quickly become highly complex ethical dilemmas that demand considerable thought and possibly even consultation with a peer or supervisor. For example, the issue of gift-giving can represent an emotionally charged transference transaction, requiring the therapist to respond with great sensitivity. In negotiating such a complex interchange, the therapist may have to walk a thin line between maintaining appropriate professional boundaries and acknowledging important transference issues.

Ethics & Boundaries in PsychotherapyIssues that come up infrequently, are highly complex or unusual, those the therapist has rarely or never encountered before, and those that pose ethical dilemmas may require some thought, research, consultation, or all three of these. The “Patriot Act” scenario introduced above may fall into this category. It is an example of a novel situation that throws complex contradictions into a boundary issue that may have been more straightforward before the introduction of this piece of legislation. Not only is it novel, but it is also likely to arouse conflicting values in the therapist. How does one simultaneously 1) observe the letter and spirit of the law, 2) protect the client’s right to privacy and confidentiality, 3) fulfill the ethical obligation of informing the client when demands have been made for private records, 4) conform to the ethical standards set forth by his or her profession’s code of ethics, and 5) satisfy personal values and boundaries?

Other issues that may pose more complex boundary challenges are situations in which there either is no clear ethical solution or in which there are multiple paths available to the therapist, all of which contain some ethical complications. Here is one example:

You have been seeing a married couple for relationship therapy for several months. They decide to divorce, and both request to continue to see you individually. You have a good therapeutic relationship with both of them, and both are in significant distress. Can you see them both without encountering boundary issues that might compromise the individual best interests of each; do you choose one or the other; or do you decline to treat either one of them?

In this scenario, if the available courses of action include seeing both, neither, or only one of the partners, all of these seem to involve some possible hazards and ethical questions. If you provide individual sessions to both partners, can you offer the kind of unequivocal support each deserves when there are adversarial issues to be resolved? Can you offer genuine impartiality when you are aware of the details of both partners’ agendas? On the other hand, if you choose to continue treating one or the other, or decline to treat either, aren’t there potential issues of abandonment?

Ethics & Boundaries in Psychotherapy is a 3-hour online continuing education (CE/CEU) course intended to give psychotherapists the tools they need to resolve the common and not-so-common ethical and boundary issues and dilemmas that they may expect to encounter in their everyday professional practice in the 21st century. Among the topics discussed are definitions of boundaries; resolving conflicts between ethics and the law; boundary crossings vs. boundary violations; multiple relationships; sexual misconduct; privacy and confidentiality in the age of HIPAA and the Patriot Act; ethics issues with dangerous clients; boundary issues in clinical supervision; ethics and cultural competency; ethical boundaries in use of social media; ethical practice in teletherapy; fees and financial relationships; and a 17-step model for ethical decision making. * This course satisfies the ethics & boundaries requirement for license renewal of Florida counselors, social workers & MFTs. Course #30-77 | 2015 | 40 pages | 21 posttest questions

Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists; the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB #1046, ACE Program); the California Board of Behavioral Sciences (#PCE1625); the Florida Boards of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling (#BAP346) and Psychology & School Psychology (#50-1635); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); and the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).