Sponsored by the HealthcareTrainingInstitute.org providing Quality Education since 1979
Add to Shopping Cart

How to Ethically Set Client Confidentiality Boundaries
Ethical Confidentiality Boundaries continuing education social worker CEUs

Section 15
Ethics and Managing Dual Relationships

Ethics CEU Question 15 | Ethics CEU Answer Booklet | Table of Contents | Confidentiality
Social Worker CEUs, Psychologist CEs, Counselor CEUs, MFT CEUs

Ethics - Managing Dual Relationships
To manage boundary issues effectively, mental health professionals must develop a clear understanding of what distinguishes ethical and unethical dual relationships. A dual relationship is unethical when it has severalRed flags How to Ethically Set Client counselor CEU characteristics (Corey & Herlihy, 1997; Epstein, 1994; NASW, 2000; Reamer, 1998a, 2001b), such as that the relationship is likely to

• interfere with the mental health professional's exercise of professional discretion
• interfere with the mental health professional's exercise of impartial judgment
• exploit clients, colleagues, or third parties to further the mental health professional's personal interests
• harm clients, colleagues, or third parties.

Mental health professionals must be especially careful to consider how cultural and ethnic norms are relevant to boundary issues (see NASW, 2000, Standard 1.05; see also Lee & Kurilla, 1997; Pinderhughes, 1994). For example, a mental health professional who conducts home visits may be reluctant to accept a family member's invitation to join the family for a meal, but may agree to have crackers and a nonalcoholic beverage so as not to violate the family's deep-seated ethnic norms related to offering food to guests. Similar issues may arise related to mental health professionals' attending family life cycle events. A pregnant community organizer may need to be very tactful when residents of a largely ethnic community invite the mental health professional to a neighborhood-sponsored shower held in her behalf. The mental health professional would need to think through the implications of attending the event and accepting gifts. As the NASW Code of Ethics (2000) states,

In instances when dual or multiple relationships are unavoidable, mental health professionals should take steps to protect clients and are responsible for setting clear, appropriate, and culturally sensitive boundaries. [italics added] (Standard 1.06[c])
To protect clients and minimize possible harm--and to minimize the possibility of ethics complaints and lawsuits that allege misconduct or professional negligence--mental health professionals should establish clear "risk management" criteria and procedures. A sound risk management protocol to deal with boundary issues should contain six major elements:

  1. Be alert to potential or actual conflicts of interest.
  2. Inform clients and colleagues about potential or actual conflicts of interest; explore reasonable remedies.
  3. Consult colleagues and supervisors, and relevant professional literature, regulations, policies, and ethical standards (codes of ethics) to identify pertinent boundary issues and constructive options.
  4. Design a plan of action that addresses the boundary issues and protects the parties involved to the greatest extent possible.
  5. Document all discussions, consultation, supervision, and other steps taken to address boundary issues.
  6. Develop a strategy to monitor implementation of action plan.

First, mental health professionals should always be vigilant in their efforts to be alert to potential or actual conflicts of interest in their relationships with clients and colleagues. Mental health professionals should be cognizant of "red flags" that may signal a boundary problem. For example, clinical mental health professionals should be wary of situations in which they find themselves attracted to a particular client, going out of their way to extend the client's counseling sessions (facilitated by scheduling the favored client at the end of the day), treating the client as someone "special," disclosing confidential information about other clients, acting impulsively in relation to the client, allowing the client to accumulate a large unpaid bill, and disclosing very personal details to the client (Simon, 1999). Similarly, nonclinical mental health professionals (for example, administrators, researchers, community organizers) should be alert to comparable warning signs, such as granting extraordinary special favors to clients or colleagues and granting unprecedented exceptions to clients or colleagues who have not fulfilled contractual agreements.

Second, mental health professionals should inform clients and appropriate colleagues when they encounter boundary issues, including actual or potential conflicts of interest, and explore reasonable remedies. Third, mental health professionals should consult colleagues and supervisors; relevant professional literature, regulations, and policies; and ethical standards (relevant codes of ethics) to identify pertinent boundary issues and constructive options. Special care should be taken in high-risk circumstances. For example, clinical mental health professionals who attempt to make decisions about a possible friendship with a former client should consider prevailing ethical standards that take into consideration such factors as the amount of time that has passed since the termination of the professional-client relationship; the extent to which the former client is mentally competent and emotionally stable; the issues addressed in the professional-client relationship; the length of the professional-client relationship; the circumstances surrounding the termination of the professional-client relationship; the amount of influence the mental health professional has in the client's life; available, reasonable alternatives; and the extent to which there is foreseeable harm to the former client or others as a result of the new relationship (Ebert, 1997; Reamer, 1998a).

Fourth, mental health professionals should design a plan of action that addresses the boundary issues and protects clients, colleagues, and third parties to the greatest extent possible. In some circumstances, protecting a client's interests may require termination of the professional relationship with proper referral of the client. It is particularly useful for mental health professionals to imagine how a thoughtful panel of peers in the profession would perceive their course of action. Fifth, mental health professionals should document all discussions, consultations, supervision, and other steps taken to address boundary issues (for example, consultation with colleagues or supervisors about whether to accept a client's invitation to attend a life cycle event or terminate services to a client when conflict of interest issues arise). Finally, mental health professionals should develop a strategy to monitor the implementation of their action plan, for example, by periodically assessing with relevant parties (clients, colleagues, supervisors, and lawyers) whether the strategy minimized or eliminated the boundary problems.

To promote practitioners' actual implementation of this protocol, mental health professionals can sponsor staff training and continuing education workshops. In addition to presenting conceptual content related to boundary issues and dual relationships, such workshops can role-play realistic case scenarios to enhance mental health professionals' ability to protect clients, colleagues, and third parties, and to reduce risk.

There is no question that mental health professionals have developed a richer, more nuanced understanding of boundary issues in the profession. To further enhance this understanding, mental health professionals must examine dual relationships that are exploitive in nature and those that are more ambiguous. Practitioners' firm grasp of boundary issues involving their intimate relationships with clients and colleagues, responses to their own emotional and dependency needs, pursuits of personal benefits, altruistic gestures, and responses to unanticipated circumstances will increase their ability to protect clients, colleagues, and themselves. Most important, skillful management of boundary issues enhances mental health's ethical integrity, one of the key hallmarks of a profession.
- Reamer, Frederic; Boundary issues in social work: managing dual relationships; Social work; Jan 2003; Vol. 48; Issue 1.
The article above contains foundational information. Articles below contain optional updates.

Personal Reflection Exercise #8
The preceding section contained information about managing dual relationships. Write three case study examples regarding how you might use the content of this section in your practice.

Ethics CEU QUESTION 15
According to Reamer, what are the six elements of a sound risk management protocol to deal with boundary issues? Record the letter of the correct answer the Ethics CEU Answer Booklet

 
Others who bought this Confidentiality Course
also bought…

Scroll DownScroll UpCourse Listing Bottom Cap

Ethics CEU Answer Booklet for this course | Confidentiality
Forward to Section 16
Back to Section 14
Table of Contents
Top

The article above contains foundational information. Articles below contain optional updates.
5 common HIPAA compliance pitfalls for healthcare orgs to avoid - Healthcare IT News - September 13, 2017

Healthcare IT News

5 common HIPAA compliance pitfalls for healthcare orgs to avoid
Healthcare IT News
HIPAA was established before these cyber threats became such an issue, which can cause some challenges with trying to keep up, said Matt Fisher, partner with Mirick O'Connell, in opening the HIPAA compliance session at the Healthcare Security Forum on ...

Layer Successfully Achieves HIPAA Compliance - Business Wire (press release) - September 14, 2017

Layer Successfully Achieves HIPAA Compliance
Business Wire (press release)
SAN FRANCISCO--(BUSINESS WIRE)--Layer Inc. today announced it has met requirements for HIPAA privacy and security compliance, demonstrating its ongoing commitment to powering the next generation of healthcare technology and increasing ...

and more »
Two Day HIPAA Compliance for Small Healthcare Providers Seminar (Boston, MA, United States - November 16-17 ... - Business Wire (press release) - September 12, 2017

Two Day HIPAA Compliance for Small Healthcare Providers Seminar (Boston, MA, United States - November 16-17 ...
Business Wire (press release)
Being in compliance with HIPAA involves not only ensuring that you provide the appropriate patient rights and controls on your uses and disclosures of Protected Health Information, but that you also have the proper policies and procedures in place. If ...

and more »
How Vendors, Providers Can Create Strong Health Data Security - HealthITSecurity.com - September 19, 2017

HealthITSecurity.com

How Vendors, Providers Can Create Strong Health Data Security
HealthITSecurity.com
September 19, 2017 - When it comes to maintaining HIPAA compliance, both healthcare providers and their chosen third-party vendors – or business associates – need to work together for comprehensive and current health data security. Compliance can get ...

and more »
AppRiver Helps Healthcare Providers Increase HIPAA Compliance - GlobeNewswire (press release) - September 11, 2017

AppRiver Helps Healthcare Providers Increase HIPAA Compliance
GlobeNewswire (press release)
Gulf Breeze, Florida, Sept. 11, 2017 (GLOBE NEWSWIRE) -- Leading cloud cybersecurity and productivity provider AppRiver, today announced a complimentary whitepaper to help healthcare professionals better understand and maintain HIPAA compliance.

and more »

CEU Continuing Education for
Social Work CEUs, Psychology CEUs, Counselor CEUs, MFT CEUs

OnlineCEUcredit.com Login


Forget your Password Reset it!