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

Section 26

Ethics CE Test | Table of Contents | Boundaries
Counselor CEUs, Psychologist CEs, Social Worker CEUs, MFT CEUs

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Peer-Reviewed Journal Article References:
Bachelor, A., Meunier, G., Laverdiére, O., & Gamache, D. (2010). Client attachment to therapist: Relation to client personality and symptomatology, and their contributions to the therapeutic alliance. Psychotherapy: Theory, Research, Practice, Training, 47(4), 454–468.

Breggin, P. R., & Stolzer, J. (2020). Psychological helplessness and feeling undeserving of love: Windows into suffering and healing. The Humanistic Psychologist, 48(2), 113–132.

Chui, H., Palma, B., Jackson, J. L., & Hill, C. E. (2020). Therapist–client agreement on helpful and wished-for experiences in psychotherapy: Associations with outcome. Journal of Counseling Psychology, 67(3), 349–360. 

Cook, R. M., McKibben, W. B., & Wind, S. A. (2018). Supervisee perception of power in clinical supervision: The Power Dynamics in Supervision Scale. Training and Education in Professional Psychology, 12(3), 188–195. 

DeCelles, K. A., DeRue, D. S., Margolis, J. D., & Ceranic, T. L. (2012). Does power corrupt or enable? When and why power facilitates self-interested behavior. Journal of Applied Psychology, 97(3), 681–689.

DeCou, C. R., Cole, T. T., Lynch, S. M., Wong, M. M., & Matthews, K. C. (2017). Assault-related shame mediates the association between negative social reactions to disclosure of sexual assault and psychological distress. Psychological Trauma: Theory, Research, Practice, and Policy, 9(2), 166–172. 

De Cremer, D., van Dijke, M., Schminke, M., De Schutter, L., & Stouten, J. (2018). The trickle-down effects of perceived trustworthiness on subordinate performance. Journal of Applied Psychology, 103(12), 1335–1357.

Ellis, D. M., Guastello, A. D., Anderson, P. L., & McNamara, J. P. H. (2019). How racially concordant therapists and culturally responsive online profiles impact treatment-seeking among Black and White Americans. Practice Innovations, 4(2), 75–87. 

Farkas, M. (2011). Review of Personal recovery and mental illness: A guide for mental health professionals [Review of the book Personal recovery and mental illness: A guide for mental health professionals, by M. Slade]. Psychiatric Rehabilitation Journal, 35(2), 158–159. 

Forde, C., & Duvvury, N. (2017). Sexual violence, masculinity, and the journey of recovery. Psychology of Men & Masculinity, 18(4), 301–310.

Geller, S. M., & Porges, S. W. (2014). Therapeutic presence: Neurophysiological mechanisms mediating feeling safe in therapeutic relationships. Journal of Psychotherapy Integration, 24(3), 178–192.

Girme, Y. U., Overall, N. C., & Hammond, M. D. (2019). Facilitating autonomy in interdependent relationships: Invisible support facilitates highly avoidant individuals’ autonomy. Journal of Family Psychology, 33(2), 154–165. 

Goldner, L. (2016). Therapists’ self-perception, attachment, and relationship: The role of selfobject needs. Psychoanalytic Psychology, 33(4), 535–553. 

Goren, E. R. (2017). A call for more talk and less abuse in the consulting room: One psychoanalyst–sex therapist’s perspective. Psychoanalytic Psychology, 34(2), 215–220.

Hakimi, D., Bryant-Davis, T., Ullman, S. E., & Gobin, R. L. (2018). Relationship between negative social reactions to sexual assault disclosure and mental health outcomes of Black and White female survivors. Psychological Trauma: Theory, Research, Practice, and Policy, 10(3), 270–275.

Hill, C. E., Lu, Y., Gerstenblith, J. A., Kline, K. V., Wang, R. J., & Zhu, X. (2020). Facilitating client collaboration and insight through interpretations and probes for insight in psychodynamic psychotherapy: A case study of one client with three successive therapists. Psychotherapy, 57(2), 263–272.

Hogeveen, J., Inzlicht, M., & Obhi, S. S. (2014). Power changes how the brain responds to others. Journal of Experimental Psychology: General, 143(2), 755–762. 

Hui, C. M., Molden, D. C., & Finkel, E. J. (2013). Loving freedom: Concerns with promotion or prevention and the role of autonomy in relationship well-being. Journal of Personality and Social Psychology, 105(1), 61–85. 

Ito, J. R. (2014). Review of Ethics for psychologists: A casebook approach [Review of the book Ethics for psychologists: A casebook approach, by L. Tien, A. Davis, T. A. Arnold & G. A. H. Benjamin]. Asian American Journal of Psychology, 5(4), 383–384.

Kachanoff, F. J., Taylor, D. M., Caouette, J., Khullar, T. H., & Wohl, M. J. A. (January 2019). The chains on all my people are the chains on me: Restrictions to collective autonomy undermine the personal autonomy and psychological well-being of group members. Journal of Personality and Social Psychology, Vol 116(1),141-165.

Kağitçibasi, Ç. (1996). The autonomous-relational self: A new synthesis. European Psychologist, 1(3), 180–186.

Karlsson, M. E., Zielinski, M. J., & Bridges, A. J. (2020). Replicating outcomes of Survivors Healing from Abuse: Recovery through Exposure (SHARE): A brief exposure-based group treatment for incarcerated survivors of sexual violence. Psychological Trauma: Theory, Research, Practice, and Policy, 12(3), 300–305. 

Katz, A. D., & Hoyt, W. T. (2014). The influence of multicultural counseling competence and anti-Black prejudice on therapists’ outcome expectancies. Journal of Counseling Psychology, 61(2), 299–305. 

Keem, S., Shalley, C. E., Kim, E., & Jeong, I. (2018). Are creative individuals bad apples? A dual pathway model of unethical behavior. Journal of Applied Psychology, 103(4), 416–431.  

Kim, S., & Rutherford, A. (2015). From seduction to sexism: Feminists challenge the ethics of therapist–client sexual relations in 1970s america. History of Psychology, 18(3), 283–296.

Kivlighan, D. M. III, Hooley, I. W., Bruno, M. G., Ethington, L. L., Keeton, P. M., & Schreier, B. A. (2019). Examining therapist effects in relation to clients’ race-ethnicity and gender: An intersectionality approach. Journal of Counseling Psychology, 66(1), 122–129.

Kivlighan, D. M., Jr., Marmarosh, C. L., & Hilsenroth, M. J. (2014). Client and therapist therapeutic alliance, session evaluation, and client reliable change: A moderated actor–partner interdependence model. Journal of Counseling Psychology, 61(1), 15–23. 

Kouchaki, M., & Wareham, J. (2015). Excluded and behaving unethically: Social exclusion, physiological responses, and unethical behavior. Journal of Applied Psychology, 100(2), 547–556.

Little, L., & Hamby, S. L. (1996). Impact of a clinician's sexual abuse history, gender, and theoretical orientation on treatment issues related to childhood sexual abuse. Professional Psychology: Research and Practice, 27(6), 617–625.

Mallinckrodt, B., & Jeong, J. (2015). Meta-analysis of client attachment to therapist: Associations with working alliance and client pretherapy attachment. Psychotherapy, 52(1), 134–139. 

Meier, S. T. (2019). Elevated trait anxiety: Obstacle to progress with female clients? Professional Psychology: Research and Practice, 50(1), 33–38.

Miano, A., Fertuck, E. A., Roepke, S., & Dziobek, I. (2017). Romantic relationship dysfunction in borderline personality disorder—a naturalistic approach to trustworthiness perception. Personality Disorders: Theory, Research, and Treatment, 8(3), 281–286.

O'Connor, S., Kivlighan, D. M., Jr., Hill, C. E., & Gelso, C. J. (2019). Therapist–client agreement about their working alliance: Associations with attachment styles. Journal of Counseling Psychology, 66(1), 83–93. 

Owen, J., Wong, Y. J., & Rodolfa, E. (2010). The relationship between clients’ conformity to masculine norms and their perceptions of helpful therapist actions. Journal of Counseling Psychology, 57(1), 68–78.

Pathé, M. (2014). Guiding mental health professionals through murky waters. Journal of Threat Assessment and Management, 1(1), 25–26.

Phelps, K. W. (2010). Review of Beliefs and illness: A model for healing [Review of the book Beliefs and illness: A model for healing, by L. M. Wright & J. M. Bell]. Families, Systems, & Health, 28(1), 70–71.

Pizer, B. (2017). “Why can’t we be lovers?” When the price of love is loss of love: Boundary violations in a clinical context. Psychoanalytic Psychology, 34(2), 163–168.

Quill, T. E. (2002). Autonomy in a relational context: Balancing individual, family, cultural, and medical interests. Families, Systems, & Health, 20(3), 229–232.

River, L. M., Borelli, J. L., Vazquez, L. C., & Smiley, P. A. (2018). Learning helplessness in the family: Maternal agency and the intergenerational transmission of depressive symptoms. Journal of Family Psychology, 32(8), 1109–1119.

Rubel, J. A., Bar-Kalifa, E., Atzil-Slonim, D., Schmidt, S., & Lutz, W. (2018). Congruence of therapeutic bond perceptions and its relation to treatment outcome: Within- and between-dyad effects. Journal of Consulting and Clinical Psychology, 86(4), 341–353.

Scoglio, A. A. J., Marine, S. B., & Molnar, B. E. (2020). Responder perspectives on justice and healing for sexual violence survivors. Psychology of Violence. Advance online publication. 

Slepian, M. L., Young, S. G., & Harmon-Jones, E. (2017). An approach-avoidance motivational model of trustworthiness judgments. Motivation Science, 3(1), 91–97. 

Soral, W., Kofta, M., & Bukowski, M. (Jul 13 , 2020). Helplessness experience and intentional (un-)binding: Control deprivation disrupts the implicit sense of agency. Journal of Experimental Psychology: General, No Pagination Specified.

Spaulding, W. (2016). Introduction to the special section: Mental health professionals with mental illness. American Journal of Orthopsychiatry, 86(6), 603.

Stenius, J., Knekt, P., Heinonen, E., Holma, J., Antikainen, R., & Lindfors, O. (2020). Predicting the working alliance over the course of long-term psychodynamic psychotherapy with the Rorschach Ego Impairment Index, self-reported defense style, and performance-based intelligence: An evaluation of three methodological approaches. Psychoanalytic Psychology. Advance online publication. 

Strauss Swanson, C., & Szymanski, D. M. (2020). From pain to power: An exploration of activism, the #Metoo movement, and healing from sexual assault trauma. Journal of Counseling Psychology. Advance online publication. 

Summers, F. (2017). Sexual relationships between patient and therapist: Boundary violation or collapse of the therapeutic space? Psychoanalytic Psychology, 34(2), 175–181.

Taber, B. J., Leibert, T. W., & Agaskar, V. R. (2011). Relationships among client–therapist personality congruence, working alliance, and therapeutic outcome. Psychotherapy, 48(4), 376–380.

The chains on all my people are the chains on me: Restrictions to collective autonomy undermine the personal autonomy and psychological well-being of group members: (2019). Correction to Kachanoff et al. Journal of Personality and Social Psychology, Vol 117(1), Jul 2019, 98.

"Therapist behavior as a predictor of Black and White caregiver responsiveness in multisystemic therapy": Correction to Foster et al. (2009) (2015). Journal of Family Psychology, 29(4), 536.

van der Hart, O., & Nijenhuis, E. R. S. (1999). Bearing witness to uncorroborated trauma: The clinician's development of reflective belief. Professional Psychology: Research and Practice, 30(1), 37-44. 

Wester, S. R., & Vogel, D. L. (2002). Working with the masculine mystique: Male gender role conflict, counseling self-efficacy, and the training of male psychologists. Professional Psychology: Research and Practice, 33(4), 370–376.

Zlotnick, E., Strauss, A. Y., Ellis, P., Abargil, M., Tishby, O., & Huppert, J. D. (2020). Reevaluating ruptures and repairs in alliance: Between- and within-session processes in cognitive–behavioral therapy and short-term psychodynamic psychotherapy. Journal of Consulting and Clinical Psychology, 88(9), 859–869. 

Additional References:
Abramson, M. "Reflections on knowing oneself ethically: Toward a working framework for social work practice." Families in Society, 1996a, 77(4), 195-202.

Aguilera, D. C. (2000). Crisis intervention: Theory and methodology. Mosby.

American Association for Marriage and Family Therapy. (2015, January 1). Code of Ethics. Retrieved from http://www.aamft.org/iMIS15/AAMFT/Content/Legal_Ethics/Code_of_Ethics.aspx

American Counseling Association. (2014). ACA Code of Ethics. Retrieved from http://www.counseling.org/docs/ethics/2014-aca-code-of-ethics.pdf?sfvrsn=4

American Psychological Association (APA). (2017, January 1). Ethical Principles of Psychologists and Code of Conduct. Retrieved from http://www.apa.org/ethics/code

Barker, R. L. (1999). Milestones in the development of Social Work and Social Welfare. NASW Press.

Barnett, Jeffrey E. (2014). Sexual Feelings and Behaviors in the Psychotherapy Relationship: An Ethics Perspective. Journal of Clinical Psychology. 70(2), 170-181.

Bemecker, Samantha L. (2014). Helping Clients Help Themselves: Managing Ethical Concerns When Offering Guided Self-Help Interventions in Psychotherapy Practice. Professional Psychology: Research & Practice. 45(2), 111-119.

Bersoff, D. N. (2012). Ethical conflicts in psychology. DC.

Brems, C. (2000). Dealing with challenges in psychotherapy and counseling. Brooks/Cole.

Bridges, N. A. (1999). Psychodynamic perspective on therapeutic boundaries: Creative clinical possibilities. J Psychother Pract Res., 8(4), 292-300.

Brill, N. (1997). Working with People. Longman.

Bucci, S., & Seymour-Hyde, A., & Harris, A., & Berry, K. (2016). Client and Therapist Attachment Styles and Working Alliance. Clinical Psychology & Psychotherapy. 23(2),155-165.

Buhari, B. (2013). Therapeutic Relationships and Professional Boundaries. IFE PsychologIA. Special Edition. 21(3-S),162-168.

Calmes, S., & Piazza, N., & Laux, J. (2013). The Use of Touch in Counseling: An Ethical Decision-Making Model. Counseling & Values. 58(1), 59-68.

Capawana, M. R., & Walla, P. (Reviewing Editor) (2016). Intimate attractions and sexual misconduct in the therapeutic relationship: Implications for socially just practice. Cogent Psychology. 3(1).

Clapton, K. (2013). Developing professional boundaries guidance for social workers. Journal of Adult Protection. 15(1), 37-44.

Easterbrook, C., & Meehanb, T. (2017). The Therapeutic Relationship and Cognitive Behavioural Therapy: A Case Study of an Adolescent Girl With Depression. European Journal of Counselling Psychology. 6(1), 1-24.

Escudero, V. (2016). Guest editorial: the therapeutic alliance from a systemic perspective. Journal of Family Therapy. 38(1), 1-4.

Gutheil, TC, PhD. (1998). The Concept of Boundaries in Clinical Practice; theoretical and risk-management dimensions. American Journal of Psychiatry. 150(2)188-96.

Halter, M., & Brown, H., & Stone, J. (2007). Sexual Boundary Violations by Health Professionals – an overview of the published empirical literature. The Council for Healthcare Regulatory Excellence.

Henderson, K. (2013). Mandated Reporting of Child Abuse: Considerations and Guidelines for Mental Health Counselors. Journal of Mental Health Counseling. 35(4), 296-309.

Gartrell, N. (1992). Boundaries in Lesbian Therapy Relationships. Women and Therapy. 12, 29-50.

Kangas, J., & Calvert, J. (2014). Ethical Issues in Mental Health Background Checks for Firearm Ownership. Professional Psychology: Research & Practice. 45(1), 76-83.

Kottler, J., PhD. (1998). Compassionate Therapy. Jossey-Bass Publishers.

Krishnaram, V., & Aravind, V., & Thasneem, Z. (2012). Boundary Crossings and Violations in Clinical Settings. Indian Journal of Psychological Medicine, 34(1), 21-24. doi:10.4103/0253-7176.96151

Dolgoff, R., Harrington, D., & Loewenberg, F. M. (2012). Ethical decisions for social work practice. Thomson Brooks/Cole.

Luedke, A., & Peluso, P., & Diaz, P., & Freund, R., & Baker, A. (2017). Predicting Dropout in Counseling Using Affect Coding of the Therapeutic Relationship: An Empirical Analysis. Journal of Counseling & Development. 95(2), 125-134.

Moe, C., & Kvig, E I., & Brinchmann, B., & Brinchmann, B. (2013). Working behind the scenes An ethical view of mental health nursing and first-episode psychosis. Nursing Ethics. 20(5), 517-527.

National Association of Social Workers. (2017). NASW Code of Ethics. Retrieved from https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English

National Board for Certified Counselors, Inc. and Affiliates. (2016, October 7). NBCC Code of Ethics. Retrieved from https://www.nbcc.org/Assets/Ethics/NBCCCodeofEthics.pdf

Olson, S., & Brown-Rice, K., & Keller, N. (2016). Mental Health Practitioners' Knowledge of Colleagues' Problems of Professional Competency. Journal of Mental Health Counseling. 38(4), 308-326.

Parth, K., & Datz, F., & Seidman, C., & Löffler-Stastka, H. (2017). Bulletin of the Menninger Clinic. Transference and countertransference: A review. 81(2), 167-211.

Penfold, P. S. (1998). Sexual abuse by health professionals: A personal search for meaning and healing. University of Toronto Press.

Peterson, M. R. (2015). At personal risk: Boundary violations in professional-client relationships. W.W. Norton and Company.

Plaut, S., & Brown, J., & Brancu, M., & Wilbur, R., & Rios, K. (2013). Characteristics of Health Professionals in a Mandated Ethics Tutorial After Violating Sexual Boundaries with Patients. Journal of Health Care Law & Policy. 16(2), 353-374.

Pope, K. S., & Bouhoutsos, J. C. (1986). Sexual intimacy between therapists and patients. Praeger.

Rankin, Mary, JD employed by Healthcare Training Institute to research and write the article Evolution of Social Work Ethics.

Reamer, F. G. (2000). The social work ethics audit: A risk-management strategy. Social Work. 45(4), 355-366.

Reamer, F. (2009). Social Work Ethics Casebook: Cases and Commentary. WNASW Press.

Reamer, F. G. (2003). Social Work Malpractice and liability: Strategies for prevention. Columbia University Press.

Reamer, F. G. (2018). Social work values and ethics. COLUMBIA University Press.

Reamer, F. G. (2006). Ethical Standards in Social Work: A Review of the NASW Code of Ethics. NASW Press.

Reamer, F. G. (2001). The Social Work Ethics Audit: A Risk-management Tool. NASW Press.

Reamer, F. G. (2001). Tangled Relationships: Managing Boundaries in the Human Services. Columbia University Press.

Reamer, F. G. (2001). Ethics Education in social work. Council on Social Work Education.

Rizvi, S. (2016). The essential aspects of building a therapeutic relationship. Indian Journal of Positive Psychology. 7(3), 359-361.

Robison, W. L., & Reeser, L. C. (2000). Ethical decision making in social work. Allyn and Bacon.

Rothstein, M. (2014). Tarasoff Duties after Newtown. Journal of Law, Medicine & Ethics. 42(1), 104-109.

Sansone, R. A., & Sansone, L. A. (2009). Crossing the line: Sexual boundary violations by physicians. Psychiatry (Edgemont), 6(6). 45-48.

Schoener, GR, PhD. (2001). Boundaries in Group Therapy: Ethical and Practice Issues. Women and Group Psychotherapy. Builford Press.

Stone, M. PhD. (1999). Boundary Violations between Therapist and Patient. Psychiatric Annals. 6(12), 670-677.

Tyler, F. PhD., & Brome, D., & Williams, J. (2001). Ethnic Validity, Ecology, and Psychotherapy. Plenum Press.

Vote, B., & Kasket, E. (2017). Therapists' experience of the therapeutic relationship when working with adults adopted as infants. Counselling Psychology Review. 32(2), 14-29.

Yonan, J., & Bardick, A. D., & Willmet, J. H. (2011). Ethical Decision Making, Therapeutic Boundaries, and Communicating Using Online Technology and Cellular Phones. Canadian Journal of Counselling and Psychotherapy, 45(4), 307-326.

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Table of Contents

The article above contains foundational information. Articles below contain optional updates.
Ethics Alive! The Ethics of SocBots: Imagining Siri and Alexa as the Next Generation of Social Workers - January 06, 2022
Can Siri and Alexa be programmed with social work values, knowledge, critical thinking, and communication skills? Is this the "new" social worker of the future? Can SocBots learn and adapt to provide better, more ethical services?
Ethics Alive! Money, Money, Money - September 26, 2021
You may be familiar with traditional forms of payment, but what about digital payments for social work services? We explore the ethics of using various means of exchange for our services.
Ethics Alive: Special Report on the 2021 Revisions to the NASW Code of Ethics - May 20, 2021
In recent additions to the NASW Code of Ethics, self-care has been added as paramount for competent, ethical social work practice. Also, social workers must take action against oppression, racism, discrimination, inequities and acknowledge privilege.
Ethical Issues With Termination Under Pandemic Conditions - April 29, 2021
Termination of services with clients has always been a consideration of social work ethics. During the COVID-19 pandemic, termination considerations became more critical for some.
Freedom To Discriminate and the Professional Obligation of Social Workers - April 19, 2021
An October 2020 decision, since reversed, would have allowed licensed social workers in Texas to discriminate, even though such discrimination is in violation of the NASW Code of Ethics.

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