Psychotherapist and patient relationship coordinator

psychotherapist and patient relationship coordinator

By Dr. Stephen Behnke APA Ethics Director Does knowledge, on the part of the psychologist or the client, that a post-termination sexual preclude the possibility of any further professional relationship between the psychologist and client. Nov 5, Clients often develop a close relationship with therapists but is it possible to become The Facts About the Therapist-Client Relationship. Apr 6, A client asks if he can pay you for psychotherapy services by doing your yard work, . plan, and strengthen the therapist-client working relationship. .. Groupie eventually became his manager and moved in with the celebrity.

Do we withdraw if they join our groups? Do we bar their membership if we can? This could include online networks, as well. You provide therapy to a child.

'Til Death Do Us Part: Does a Client Ever Stop Being a Client?

Ten, fifteen, or more years later, that patient becomes a prominent, top in their field, attorney, surgeon, or other highly specialized professional. You discover that you need someone with those highly specialized qualifications. If the client is still a client even after all those years of no contact, is that a conflict of interest and a prohibited dual relationship? If it is an issue of power, who is in the position of power? Is power in any relationship always static, or is it variable and subject to change based on the circumstances?

Dual or Sequential Relationship When a therapist and client enter into a relationship that is outside of or in addition to the therapeutic relationship, it is generally referred to as a dual relationship. Dual relationships are discouraged by most professional organizations. However, not all experts in the field believe that all dual relationships are necessarily harmful.

It would depend on the context. However, when a therapist and long past patient enter into a relationship separate from the therapeutic one, is that actually a dual relationship?

'Til Death Do Us Part: Does a Client Ever Stop Being a Client? - jingle-bells.info

Would it be more accurate to call it a sequential or serial relationship? Is there a difference? If one believes that our patients grow mature and sometimes surpass us in knowledge, wisdom, and power, then it is a significant difference. Of course, of all the dual or sequential relationships that are potentially possible with patients and former patients, when the issue of sex comes up, most all therapists of all disciplines react forcefully.

Having sex with a current patient or even a recently discharged patient is not only unethical—it is illegal. It is truly a betrayal of the trust the patient places in us. However, over time as in yearscan that change in some very special circumstances to allow exceptions to the rule? If a therapist and former patient meet some 10 or 15 years after the last therapeutic session and develop a personal relationship, get married, and have children, can we say that an ethical violation or a crime has been committed?

Washington State is one exception. However, assuming the former client does not file any complaint, how enforceable would such laws be? For example, what if the former therapist and patient got married, were in a committed relationship, and had children? Would or should an ethics committee have the authority to interfere with a marriage or union among consenting adults? What about our belief in the right to free association? What is the rationale for the prohibition against sex with patients?

Many believe it is the power differential. Behnke points out that many relationships have significant power differentials, including partnerships and marriages, and that we often do in fact put our own interests above those of clients when we charge fees, for example.

So, neither a power differential nor putting our own needs first is in and of itself unethical. Rather, Behnke says, it is because we have a fiduciary relationship that is compromised and creates additional risks that are not a necessary part of the therapeutic relationship, making psychotherapy impossible. But fiduciary relationships are not static and change with time and circumstances. Some would argue it is based on psychodynamic theory, and perhaps those who practice psychoanalytically have a higher standard.

But interestingly, there is nothing in psychodynamic theory or psychoanalysis that would state such. This would include taking patients on vacation and conducting analysis in hotel room beds. Sexual and business relationships, for example, pose inherent risks regardless of who is involved. Neither can be defended as reasonable dimensions to impose on a therapy relationship. Finally, we will comment on how easy it is to rationalize, to convince ourselves that an action is justifiable in a particular situation.

All therapists are vulnerable to self-delusion when their own needs get in the way, even those who are competent and have been scrupulously ethical in the past e. Risk Assessment Kitchener suggests assessing the appropriateness of boundaries by using three guidelines to predict the amount of damage that role blending might create.

Role conflict occurs, says Kitchener, when expectations in one role involve actions or behavior incompatible with another role. First, as the expectations of professionals and those they serve become more incompatible, the potential for harm increases. Second, as obligations associated with the roles become increasingly divergent, the risks of loss of objectivity and divided loyalties rise.

Third, to the extent that the power and prestige of the psychotherapist exceeds that of the client, the potential for exploitation is heightened.

psychotherapist and patient relationship coordinator

Thus, if after two years of intense therapy and a tenuous termination whereby the client may need to return at any time, no additional roles should be contemplated. The success or failure of this new role relationship would be more about what the parties do as consenting adults as opposed to the brief professional experience.

Brown adds two additional factors that, if present, heighten the risks of harm.

psychotherapist and patient relationship coordinator

Second, boundary violations usually arise from impulse rather than from carefully reasoned consideration of any therapeutic indications. Thus, hugging a client is not unethical per se, but an assessment of any potential hazards or misunderstandings should precede such an act.

Risky Therapists All therapists face some risk for inappropriate role blending Keith-Spiegel, Those with underdeveloped competencies or poor training may prove more prone to improperly blending roles with clients. However, even those with excellent training and high levels of competence may relate unacceptably with those with whom they work because their own boundaries fail. Some may feel a need for adoration, power, or social connection. The settings are private and intimate.

The authority falls on the side of the therapist.

psychotherapist and patient relationship coordinator

Moreover, if things turn sour, the therapist can simply eliminate the relationship by unilaterally terminating the client and can deny that anything untoward occurred should a complaint be initiated by a client.

Indeed, when a client walks through the door, immediate clues become apparent: Multiple authors have discussed the advantages of self-disclosure. Done thoughtfully and judiciously, revealing pertinent information about oneself can facilitate empathy, build trust, and strengthen the therapeutic alliance e. However, those who engage in considerable and revealing self-disclosure with clients stand at greater risk for forming problematic relationships with them.

Instead, this client began to feel that the therapy environment was polluted rather than safe and clean. She quit therapy feeling even more adrift. It is difficult to know in advance how a given client will respond to a self-disclosure, particularly when the subject is in sensitive territory for the client.

It seems reasonable to expect that some clients would want to know as much as possible about the person in whom they are placing so much trust. A skillful therapist can respond without demeaning the client in the process. At the same time Internet searches make considerable information on anyone readily available.

Like any other individual who prefers some modicum of privacy, psychotherapists must understand that information posted on personal and social sites will become known to curious clients and may lead to inquiries or promote some other types of boundary blurring. See Kolmes, ; Reamer, The next case involves an indignant response to a fading career, compounded by an absence of close ties with family or friends.

Grandiose might elicit some sympathy were it not for her ill-conceived approach to dealing with her own issues. A well-known and outspoken therapist, Panacea Grandiose, Ph. However, Grandiose continued to maintain a successful practice, and her clients became the focus of her life. She hosted frequent social events in her home and invited herself along on clients' vacations. It seems that something about therapists either choosing to work in isolation, or the isolating conditions themselves, foster the potential clouding of professional standards of care.

Or perhaps some therapists have experienced rejection by their colleagues, as with Dr. Grandiose, and turn to inappropriate substitutes for support and validation.

Regardless of the reason, an insular practice with no provisions for ongoing professional contact diffuses professional identity, thus putting appropriate decision-making at risk.

Therapeutic Orientation and Specialty Practices Some therapists practicing within certain therapeutic orientations are probably more vulnerable to charges of boundary violations. For example, Williams notes that humanistic therapy and encounter group philosophies depend heavily on tearing down interpersonal boundaries. Such therapists often disclose a great deal about themselves, hug their clients, and insist on the use of first names.

These therapists also become, according to Williams, vulnerable to ethics charges even though their practice is consistent with their training. Some therapists who specialize in working with a particular population or in certain settings may need to exercise extra vigilance because the nature of the services or service settings are conducive to or even require relaxed boundaries. In such instances, very fuzzy edges may constitute an inherent element of practice rather than qualifying as inappropriate.

Devine experienced deep sadness, hopelessness, and questioned her faith. At that time, Pew was dealing with his own troubles and struggling to manage his large congregation. Devine relayed her feelings, blaming God for having forsaken her, Rev. Pew responded by pouring out details of his own family problems, including the particulars of a drinking problem in his youth.

Pew hoped this intense session would prove helpful, figuring that Devine would gain confidence from knowing that even he had to face and overcome hardships. Devine, however, became upset by these revelations, passed them along to other parishioners, and left the church.

He also interjected too much of his own life while failing to recognize that Ms. Devine asked Pew for spiritual guidance only.

psychotherapist and patient relationship coordinator

Pew should have focused on his role as a pastor and simultaneously referred Ms. Devine to someone competent to treat her depression. However, therapists who belong to a religious community as parishioners can also easily experience challenging multiple roles. Funnel Mask sought the professional assistance of Shudi Tell, M.

Mask needed to talk to someone because, as the church treasurer, he was embezzling small amounts of money every week. He was in debt due to family illnesses, and seemed to want Mr. Tell attempted to convince Mask to create some plan to make things right, but Mask expressed disappointment and left the room.

Tell is in a bind. Even if he told someone, Mask had hidden his tracks well and could deny it. Finally, as job prospects become tighter, therapists have invented new marketplace niches for themselves.

psychotherapist and patient relationship coordinator

Fido, the parents complained, charging him with incompetence. Fido defended himself by saying that he was a licensed professional who loved dogs and that the family interfered with his relationship with the animal in ways that derailed the therapy.

This defense was not persuasive to an ethics committee. Training standards for many offshoots of psychotherapy are virtually nonexistent, expectations on the part of clients run high, and boundaries seem more likely to become confusing for both clients and therapists. Risky Career Periods No matter how long you have practiced as a mental health professional, specific risks link to each career development period. We will briefly describe those that can be associated with early, mid-level, and later career stages.

Therapists who engage in inappropriate role blending often come from the ranks of the relatively inexperienced. Many have come from graduate programs where students developed complex relationships with their educators and supervisors. It may be that many therapists new to functioning independently have had an insufficient opportunity to observe professionals who have put appropriate boundaries in place.

Kat Kopy, LCSW, enjoyed her last supervisor because he was funny and flirty and took her out for drinks after every session. She decided that her clients would benefit from the same kind of relationship. Her client, Roger Rage, misunderstood her affable demeanor and their after-session coffee house excursions, and assumed that she was attracted to him. When she recoiled as Roger attempted a kiss on her lips, he felt humiliated and angry.

He slapped her face hard, breaking her glasses. The mid-career period can pose risks for those therapists whose professional or personal life has not panned out according to the dreams of their youth.

Divorce or other family-based stresses involving teenage or young adult children, onset of a chronic illness, and apprehension about aging as well as other mid-career difficulties can impair professional judgment. Research findings reveal that the majority of therapists who engage in sexual relationships with their clients do so while middle-aged.

The next cases illustrate what can go wrong. When a young woman whose self-esteem needed boosting showered praise on him, he anticipated her sessions above all others. Therapy was often followed by coffee and soon more extensive outings together and eventually ended up in a motel where the proprietor did not expect guests to bring luggage or stay for more than a couple of hours. Pondent thought it best to terminate therapy as the relationship became more intimate, thinking that would shield him from future criticism.

Unfortunately for him, the now ex-client became more insistent that they see each other even more often and in nicer places. Pondent, who had no intention to leave his family, tried to call off the affair. The ex-client was furious, felt abandoned and rejected, and contacted an ethics committee. Her evidence against him consisted of emails, text messages and compromising photographs she had surreptitiously taken with her smart phone.

Story adapted from Keith-Spiegel, He told his life story to one of his longer-term clients who tried to console Dr. Singleman by offering him a free apartment to get through a transition period.

However, after a few months the client suggested that Dr. Singleman should move on to his own place. Singleman became upset and terminated the client. He also refused to move, forcing the client to go through an ugly eviction process. He was ultimately expelled from his professional association and lost his license to practice.

Singleman appears to have become himself emotionally impaired, and his own client was ultimately forced to bear the brunt of it. Another elevated risk period can occur at the far end of the career cycle.

Pepper discusses the psychodynamics of charismatic, grandiose, authoritarian senior therapists who may harm clients by encouraging complicated multiple relationships. We know of ethics cases involving therapists who have practiced for 40 or more years who illustrate this phenomenon. Here is just one: Groupie eventually became his manager and moved in with the celebrity. Risky Clients Not every client can cope with unintended effects of boundary crossings. Trust issues often lie at the heart of the matter.

Clients seen at social service and other out-patient community agencies may become disenfranchised due to deficits in cognition, judgment, self-care, and self-protection, as well as holding little social status and power. Clients who have experienced victimization through violent attacks or abuse due to difficulties with trust or ambivalence surrounding their caretakers also benefit from clear boundary setting, despite their frequent testing of such boundaries Borys, Clients with self-esteem or individuation problems often depend on the constant approval of others for confirmation.