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

Section 10
Ethics - Boundary Violation

Question 10 | Ethics CE Test | 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 following 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

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.

Peer-Reviewed Journal Article References:
Alvarez-Hernandez, L. R., Bermúdez, J. M., Orpinas, P., Matthew, R., Calva, A., & Darbisi, C. (2021). “No queremos quedar mal”: A qualitative analysis of a boundary setting training among Latina community health workers. Journal of Latinx Psychology, 9(4), 315–325.

Contrastano, C. M. (2020). Trainee’s perspective of reciprocal vulnerability and boundaries in supervision. Journal of Psychotherapy Integration, 30(1), 44–51.

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.

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. 

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

Wu, K. S., & Sonne, J. L. (2021). Therapist boundary crossings in the digital age: Psychologists’ practice frequencies and perceptions of ethicality. Professional Psychology: Research and Practice.

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

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