talk next about objectively resolving conflicts of interest in the therapeutic
relationship regarding the focus of your session. Focus, of course, refers to
your skills in concentrating both your efforts and your client's efforts on the
significant aspect of a situation that requires work, and in retaining that focus
until some conclusion has been reached. Session focus involves thorough consideration
and may be applied to understanding one aspect of the problem under study or one
alternative for solution.
3 Ethics Conflicts of Interest in the Focus of the Session
Conflict # 1 - Amount of Time
Conflicts of interest in the focus of the session
might include the amount and length of time spent, for example, on self-disclosure.
I recently had to set a boundary regarding financial conflict with a client when
he mentioned he saw me in the bank where he worked as a loan officer. I mentioned
I did my banking there. He then started to spend a portion of the session giving
me financial advice.
When he asked what my annual income was, I realized the focus
of the session was creating a conflict of interest with goals he had set in prior
sessions. I then refocused the session by stating, "Why don't we get back
to the anger you feel toward your son." At a later point in time I used his
avoidance of dealing with deep issues as a learning tool.
Conflict # 2 - Shifting Focus & Content
a minute now and think of a recent session you had with a client where the focus
of the session, you feel, in hindsight should have been shifted. What was said
by you or the client that springboarded the focus-shift? Was an ethical boundary
crossed? Or in the future, is this creating a possible scenario where an ethical
boundary could be crossed? Is the focus of the session too narrow, only considering
one aspect of the situation, or is it too broad and not focused? How much do you
let the client control the session content? And at what point and how do you get
the client to focus?
Conflict # 3 - Client Self Determination
typical example of a focusing conflict-of-interest for me is found when a client
is seeking a divorce. I, as I'm sure you do, have clients come to me in two extreme
states. Betty says, "I want to stay married no matter what." James states,
"I want a divorce now and don't want to consider any alternatives."
The conflict-of-interest between client self determination and your basic therapeutic
goal to foster client growth exists here.
A way for you to resolve this issue
is to wait for, what professionals in education would call, the "teachable
moment." I use my gut level instincts to look for a time when it feels right
to shift the focus of the session to the suggestion of considering other alternatives.
The best indicator is during a low emotional depressed time, when the client indicates
what they are doing isn't working. The context of "behavior not working"
is often my cue to shift focus and suggest alternatives.
3-Step Ethics Technique: Partialization Boundaries in a Crisis Situation
Focus brings us naturally into a discussion about the partialization boundary.
As mentioned earlier, the therapist's responsibility is to assess the totality
of the client's situation, help break it down into manageable units, and help
the client think about and decide what action, if any, should be taken.
an example of how I use partialization related to a crisis situation in such a
way as to minimize conflict of interests in the therapeutic relationship. In crisis
intervention, I help a client start partializing a problem to reduce the client's
strong anxiety reaction or panic which in an extreme form, as you know, this panic
can become self-perpetuating and even physically dangerous.
Step # 1 -
To start the partialization
process, I first state something like, "I have to stop you from pacing now."
Or "You need to stop talking about the accident now." Or to a battered
wife I state, "You need to move on now to think about how to get you ready
to leave today."
Step # 2 -
Once the structure has been set, I ask the client to find
a prompt in the room to place total attention on. I ask them to describe it. This
serves to shift their focus away from the distressing thoughts. I say, "To
calm yourself, find something in the room upon which to focus."
Step # 3 -
cases, if the client is hyperventilating, I ask them to breathe into a paper bag
that prevents over-breathing. Thus, I am in the beginning stages of partializing
the crises by starting to control their panic. Now obviously a conflict of interest
would arise if I became emotionally involved with the clients upset. So to eliminate
this possibility I use a low, slow, caring voice while giving reassurance of their
safety and setting boundaries.
Ethics CEU QUESTION 5
What is one reason to use partialization? To select and enter your
answer go to .