Maintaining Boundaries in an Online World

Maintaining Boundaries in an Online World

One of the mainstays of ethical practice and effective therapeutic practice is the maintenance of clinical boundaries. Clear boundaries are necessary in order for both therapist and client to understand the nature and purpose of their relationship with each other. Boundaries in therapy distinguish psychotherapy from other types of relationships. Confusion about the therapist-client relationship can only interfere with the goals and process of psychotherapy. A client who comes to view the therapist as a friend, lover, or business associate – anything other than his or her source of professional help – is likely to have difficulty making use of the therapeutic alliance. In consideration of the implicit power imbalance that exists between therapist and client, the burden of responsibility for maintaining boundaries always falls upon the therapist.

Blurring of Roles

One of the many challenges to professional boundaries posed by participation in social networking is the fuzziness surrounding online relationships. There are actually at least two dynamics that need to be discussed here. The first is the blurring of the lines between personal and professional relationships, and the second is a phenomenon that seems to influence some individuals to self-disclose or act out more intensely online than they would in person.

The Online Disinhibition Effect

Complicating the picture further is a phenomenon that has been termed by Suler (2004) as the “online disinhibition effect.” This is essentially the observation that while online, some people self-disclose or act out more frequently or intensely than they would in person. People online tend to have a loosening of both behavioral inhibitions and boundaries. Self-disclosure in itself can be therapeutic, of course, but too much disclosure with loose boundaries can lead to toxic disinhibition and embarrassing content online. Researchers have found that three factors facilitate online disinhibition: anonymity, invisibility, and lack of eye contact (Lapidot-Lefler, 2015).

Social Hyperreality

Introducing further complexity into the equation is Borgmann’s (1984, 1992, 1999) early conceptualization of social hyperreality. He called it the device paradigm, described as “a technologically-driven tendency to conform our interactions with the world to a model of easy consumption… the way in which online social networks may subvert or displace organic social realities by allowing people to offer one another stylized versions of themselves for amorous or convivial entertainment.” I.e., the online version of a person may be very different than the person in real life.

In this light, not only do therapists and their clients have to assimilate new and startling data about each other found in online media, they also have to discern whether it represents the real person or his/her digital avatar.

The upthrust of all of this is that therapists must go to extraordinary lengths to assure that their therapeutic relationships do not devolve into something less than what is required for single-minded attention to the best interests of their clients. Even an established and carefully constructed therapy relationship can be unwittingly unraveled by a chance encounter on Facebook. Even when the therapist is mindful of professional boundaries and judicious in the use of self-disclosure, an indiscreet posting or picture on his or her social network page – when viewed by a client – can largely undo prior efforts.

Course excerpt from:

Ethics and Social MediaEthics and Social Media is a 2-hour online continuing education (CE) course that examines the use of Social Networking Services (SNS) on both our personal and professional lives. Is it useful or appropriate (or ethical or therapeutic) for a therapist and a client to share the kinds of information that are routinely posted on SNS like Facebook, Twitter, and others? How are psychotherapists to handle “Friending” requests from clients? What are the threats to confidentiality and therapeutic boundaries that are posed by the use of social media sites, texts, or tweets in therapist-client communication?

The purpose of this course is to offer psychotherapists the opportunity to examine their practices in regard to the use of social networking services in their professional relationships and communications. Included are ethics topics such as privacy and confidentiality, boundaries and multiple relationships, competence, the phenomenon of friending, informed consent, and record keeping. A final section offers recommendations and resources for the ethical use of social networking and the development of a practice social media policy. Course #20-75 | 2016 | 32 pages | 15 posttest questions

Click here to learn more.

Course Directions

Our online courses provide instant access to the course materials (PDF download) and CE test. Successful completion of the online CE test (80% required to pass, 3 chances to take) and course evaluation are required to earn a certificate of completion. Click here to learn more. Have a question? Contact us. We’re here to help!

Professional Development Resources is a nonprofit educational corporation 501(c)(3) organized in 1992. We are approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners; and are CE Broker compliant (all courses are reported within a few days of completion).

Target Audience: PsychologistsCounselorsSocial WorkersMarriage & Family Therapist (MFTs)Speech-Language Pathologists (SLPs)Occupational Therapists (OTs)Registered Dietitian Nutritionists (RDNs)School Psychologists, and Teachers

Earn CE Wherever YOU Love to Be!

Multiple Relationships Revealed

Multiple Relationships RevealedA female psychologist works with a male patient for about one year in a suburban area. They agreed to meet weekly for the first four months of psychotherapy, and then they agreed to meet twice per month. They developed a good therapeutic alliance. During the course of their work, he discussed significant facts about his troubled past, numerous details about failed past relationships, and sexual fantasies. The main therapeutic issues are depression and loneliness.

During the current session, the patient related having made a new female friend. As social isolation, loneliness and depression are regular themes in treatment; the psychologist frames this as positive progress.

As the conversation continues, the psychologist is surprised to learn that the patient’s new friend is the ex-wife of the psychologist’s husband. The patient reveals that he became aware of that information after several dates and recently felt comfortable revealing this to the psychologist. He also indicated that the relationship is taking on a more serious tone.

The ex-wife moved back to the area about six months ago. The psychologist knows that the ex-wife had been struggling with isolation and loneliness as well. The psychologist, her husband, and his ex-wife are on good terms. They see her regularly for informal family events and do holidays together with their adult children and grandchildren.

After the session is over, the psychologist has time to reflect on her concerns. The psychologist feels stuck and overwhelmed by her present situation. She calls you for an ethics consult.

  • What are the ethical issues involved?
  • What would you suggest that she does?
  • With whom does the psychologist discuss the multiple roles?
  • With only the patient?
  • With the patient and the ex-wife?
  • With her husband, the patient and the ex-wife?
  • Can the psychologist continue the treatment relationship with the patient?
  • Even if they terminate therapy, how does the psychologist cope with family gatherings since she knows significant details about her patient’s life?


Enhanced by Zemanta

Ethics in Therapy: Quick Tips I

Ethics in Therapy

Click on image to view course webpage

This new online CE course addresses a variety of ethics topics in the form of seven archived articles from The National Psychologist and is intended to provide psychotherapists of all specialties with a set of brief, practical tips for dealing with ethical dilemmas that present themselves in everyday practice.

Topics Include:

Office ‘Bookstore’ Should Not be for Profit
By Jeffrey E. Barnett, PsyD, ABPP

Psychologists frequently make recommendations to clients for books to read, workbooks and CDs to use, and even movies or television shows to view. In fact, bibliotherapy, the integration of such media into ongoing psychotherapy is a widely used and often highly effective addition to psychotherapy. Learn the issues involved to avoid crossing any boundaries.

Ethical, Effective Marketing for Your Private Practice
By Susan Giurleo, PhD

Many psychologists are cautious, confused and unsure of how to market their work. Many worry that marketing is unethical and something that we should not consider as we pursue a private practice career. Learn effective, ethical marketing techniques you can use to market your practice.

Law Impacts Psychology
By Richard Lawlor, PhD, JD

Over the past several years many articles have appeared in this newspaper for practitioners dealing with various aspects of psychology and the law. Some dealt with a substantive area of psychology and its impact on the law, for example research on children’s memories and the implications for interviewing children and using them as witnesses. Discover the areas of law that psychologists need to be aware of, and understand.

Duty to Warn is Now Duty to Protect
Review by Milton F. Shore, PhD, ABPP

Book review of: The Duty to Protect: Ethical, Legal and Professional Considerations for Mental Health Professionals by Werth, J.L., Welfel, E. and Benjamin, G.A.H. (Eds.) 2009. Washington, D.C. American Psychological Association.

Test Givers Must be Qualified
By Jeffrey E. Barnett, PsyD, ABPP

As a busy professional, it makes great sense to utilize others when it is appropriate to do so. This can be a much more efficient way to work than doing everything yourself. But, the situation is more complex when clinical activities are involved. Learn the ethical issues, laws and regulations for use of non-licensed subordinates in the provision of clinical services.

To Collect or Not to Collect?
By Ofer Zur, PhD

In today’s economy and financial difficulties the questions regarding fees and debt collection from clients seem to be more frequent and more relevant. In times of economic crisis, many people who have lost their homes or jobs understandably seek psychotherapy to better cope with stress due to mounting debt and loss. Explore the relevant professional, relational, clinical, ethical, legal and unintentional consequences aspects of this issue.

Duty to Warn, Protect Differs in HIV Cases
By Jeffrey E. Barnett, PsyD, ABPP

The situation where a client who is HIV-positive or who has AIDS reports having unprotected sex with another person or having done so in the past raises a number of ethical challenges. Explore the relevant issues of informed consent, confidentiality and exceptions to confidentiality, laws concerning the duty to warn and protect when threats of dangerous behavior are made and case law that may impact these areas.

Add to FacebookAdd to DiggAdd to Del.icio.usAdd to StumbleuponAdd to RedditAdd to BlinklistAdd to TwitterAdd to TechnoratiAdd to Yahoo BuzzAdd to Newsvine

Enhanced by Zemanta

50% Off Florida Required Courses

This week only Florida Mental Health Professionals (Counselors, Social Workers & MFTs) can save 50% on the required continuing education courses for their March 31, 2011 license renewal!

Featured Online Courses:

Preventing Medical Errors in Behavioral HealthPreventing Medical Errors in Behavioral Health – This course is intended to increase clinicians’ awareness of the types of errors that can occur within mental health practice, how such errors damage clients, and numerous ways they can be prevented. Its emphasis is on areas within mental health practice that carry the potential for “medical” errors. Examples include improper diagnosis, breach of confidentiality, failure to maintain accurate clinical records, failure to comply with mandatory abuse reporting laws, inadequate assessment of potential for violence, and the failure to detect medical conditions presenting as psychiatric disorders (or vice-versa). It includes detailed plans for error reduction and prevention like root cause analysis, habitual attention to patient safety, and ethical and legal guidelines. The course includes numerous cases illustrations to help demonstrate common and not-so-common behavioral health errors and specific practices that can help clinicians become proactive in preventing them. 2010 | 2 Hours CE | 31 pages | 15 posttest questions | Course #20-10B | Regular Price: $28 – Sale Price: $14!

Ethics & Boundaries in PsychotherapyEthics & Boundaries in Psychotherapy – This course gives psychotherapists the tools they need to resolve the common ethical and boundary issues and dilemmas that they may expect to encounter in their everyday professional practice. Privacy and confidentiality, multiple relationships, conflicts of interest, self-awareness, therapy with families and couples, personal, cultural and religious values, duty to warn, duty to protect, professional accountability, supervision and peer consultation, fees and fee setting are all permeated with boundary issues. 2006 | 3 Hours CE | 43 pages | 20 posttest questions | Course #30-12 | Regular Price: $36 – Sale Price $18!

Domestic Violence – Intimate Partner ViolenceThis is a web-based course requiring an internet connection to access the required online reading materials. Course instructions provide direct links to the 6 public-access online documents. Domestic violence takes many forms, including intimate partner violence, child abuse and neglect, and elder maltreatment. Awareness of domestic violence is essential for all professionals involved in clinical care. Identification of domestic violence and appropriate referrals can result in significant and meaningful change, including both a reduction of personal suffering and a reduction of long-term costs to society in terms of health care, legal involvement, and lost productivity. Inappropriate responses, or lack of responses, may both result in considerable harm; therefore, clinician education is fundamental to ensuring that standards of care are consistently implemented across healthcare systems. This course begins with a definition of intimate partner violence from the Centers for Disease Control and Prevention (CDC), followed by fact sheets with statistics and hotline referral numbers, information about risk and protective factors for becoming an abuser or victim, assessment measures compiled by the CDC, information on referral, links to resource pages filled with a variety of essential tools for change, and Florida-specific information regarding statistics and referral options. Course #20-47 | 2011 | 14 posttest questions | 5 page course download includes instructions, links to online reading materials, and posttest questions | Regular Price: $18 – Sale Price $9!

Professional Development Resources is approved as a provider of continuing education by the Association of Social Work Boards (ASWB Provider #1046, ACE Program); by the National Board of Certified Counselors (NBCC Provider #5590); by the American Psychological Association (APA); and by the National Association of Alcoholism & Drug Abuse Counselors (NAADAC, Provider #000279). Professional Development Resources is also approved by the Florida Board of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling (Provider #BAP346) and is CE Broker compliant.