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Ethical Boundaries in Balancing the Power Dynamic in the Therapeutic Relationship
Ethics Boundaries continuing education counselor CEUs

Section 18
Ethics - Boundary Violation - Consumer Information

Ethics CEU Question 18 | Ethics CEU Answer Booklet | Table of Contents | Boundaries
Social Worker CEUs, Counselor CEUs, Psychologist CEs, MFT CEUs

Various pamphlets and lists have been produced for patients to help them detect when boundary violations are occurring or may occur. For this reason, we feel the mental health professional might be interested in the sexual abuse Ethical Boundaries psychology continuing educationfollowing information provided to consumers. Warning signs of a possibility that the health professional could become sexually exploitative include the following:

1. The health professional brings up his personal problems.
2. Sex is brought up out of context, and discussion of sex is emphasized in sessions. Sex may be put forward as the answer to the patient’s problems.
3. Sessions are booked at odd hours or when there are no other staff in the office.
4. Sessions are arranged outside the office, or the patient is invited for a meal or other social occasion.
5. Forming a close personal relationship with the professional is presented as part of the treatment.
6. The professional directs the patient on how to behave and what to do in everyday life. This may include directions about engaging in certain kinds of sexual behavior.
7. The professional presents himself as the expert who has answers to every problem.
8. The patient is urged to become dependent on the professional and to separate from family and close friends.
9. The patient’s assertive behavior is criticized.
10. Touching, such as hand-holding and hugging, is presented as a necessary or even central part of the treatment.
11. Alcohol or drugs, for use of the patient and professional, are made available during office visits.
12. Gifts are given to the patient.
13. Personal letters are written to the patient; unnecessary phone calls are made to the patient.
14. Fees, when applicable, are waived for treatment sessions.
15. The patient is directed to alter her physical appearance or dress to become more sexually attractive.
16. The patient is not getting help for the problem that took her to the professional in the first place.
17. The relationship feels uncomfortable, ambiguous, or confusing to the patient.
18. With survivors of sexual abuse, the professional seems to be titillated by details of the abuse.
Susan Penford

Ethics - Ten Scenarios That Lead to Personal Contact Boundary Violations
One way to understand how abuse can be initiated by a professional is to examine the portrayals of therapist’s characteristics or behavior that lead to sexual exploitation.
1. Role trading: Patient and therapist exchange roles, and the therapist’s needs come first.
2. Sex therapy: The therapist manipulates the patient into believing that sexual intimacy is a valid treatment technique.
3. As if . . . : The therapist ignores the patient’s transference and assumes that their intense and possibly erotic attachment is a sign that they are in love with the therapist.
4. Svengali: The therapist induces and takes advantage of an intense dependency on the part of the patient.
5. Drugs: These are used to facilitate the seduction.
6. Rape: Threats, intimidation, or physical force are used by the therapist.
7. True love: The therapist conceptualizes the relationship as a courtship or romance and tries to discount the formal professional nature of the relationship.
8. It just got out of hand: The therapist does not give sufficient attention, care, and respect to the emotional intimacy that develops in the therapy.
9. Time out: The therapist considers that the principles and expectations of the therapeutic relationship cease to exist between scheduled sessions or outside the therapist’s office.
10. Hold me: The therapist takes advantage of the patient’s need for physical contact and the possible confusion between this and erotic contact.
Kenneth S. Pope

Sexual Boundary Violations by Health Professionals -
An Overview of the Published Empirical Literature

- Halter, M. Brown, H., and Stone, J. (2007). Sexual Boundary Violations by Health Professionals – an overview of the published empirical literature. The Council for Healthcare Regulatory Excellence.
The article above contains foundational information. Articles below contain optional updates.

Personal Reflection Exercise #4
The preceding section contained information provided to consumers regarding boundary violations. Write three case study examples regarding how you might use the content of this section of the Manual in your practice or to evaluate clients that may misinterpret your actions

What are potential clients warned about concerning boundaries and the power dynamic in consumer information? To select and enter your answer go to Ethics CEU Answer Booklet.

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Table of Contents

The article above contains foundational information. Articles below contain optional updates.
Ethics Alive! When You Have Ethical Concerns: Initiating NASW’s Professional Review Process - September 16, 2019
You have concerns about a social work colleague's conduct. What are your ethical obligations? What is the best way to proceed? Reporting to the National Association of Social Workers is one option. Is it warranted, and what does it entail?
Insisting on a New "R" Word: Respect - August 07, 2019
Speaking out against disrespectful language is one way social workers can practice the social work value of respecting the dignity and worth of all people.
Ethics Alive! Using Ethics Consultation: What, Why, When, Who, and How - July 08, 2019
Ethics consultation is a process of facilitating critical thinking and empowering social workers (or others) to make effective decisions regarding ethical dilemmas, violations, questions, and processes for dealing with them.
Dialogues on Gun Violence: The Role of Social Work Values and Principles - April 17, 2019
As we approach conversations on gun violence, we need to keep in mind social work values of integrity, respect, human relationships, and competence.
Ethics Alive! Religious Freedom and Social Work: Ethics of Referring Clients - January 01, 2019
Allan Barsky explores religious freedom in the context of social work practice, specifically whether it is ethical for social workers to cite religious differences with clients as the basis for referring clients to other workers.

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