Setting Clear and Ethical Boundaries with Clients (Abbreviated 6) - 5 hrs

Domestic Violence can be defined as a “pattern of coercive control that may be psychological, economic, or sexual in nature, reinforced by one of more acts of frightening physical violence, credible physical threat, isolation, emotional abuse or sexual assault. Abusive behaviors may include but are not limited to the following: pushing, shoving, hitting, choking, kicking, injuring pets or property, accusations, name-calling, put-downs, threats against a person or their children, threatening self-harm, controlling the money, not allowing a person to work, not allowing the person to associate with certain people, deprivation of transportation and forcing sex."

As practitioners dealing with clients in domestic violence situations, boundary issues have the potential to arise between the client/therapist as well as the therapist and other agencies involved with the client. The therapist also might need to deal with his or her own issues regarding domestic violence.

First, let’s examine potential boundary issues between the client and therapist. Oftentimes, the client tries to engage the therapist into doing things for them. For example, Joan asked her therapist to find someone to keep her children because she was afraid that the Department of Human Services would take them into custody.

Those of us that work with the human service agencies know that either one of two things happen: 1) children sometimes get taken out of their homes prematurely or more likely, 2) children who report domestic violence to counselors who are mandated to report the DHS are not removed from the home and many times suffer harsh consequences from the batterer for talking to outsiders in the first place. Thus, a therapist might very well be tempted to go around the system and try to find a safe place for the children.

In this case, Joan’s therapist assisted Joan in coming up with a list of possible safe havens for her children without making a recommendation or finding a place for the children herself. The therapist also helped Joan come up with a safety plan for her and her children in the event the batterer (Joan’s live in boyfriend) became abusive. Another issue which is similar to this one is that the client asks the therapist not to divulge information to human services. This puts the therapist in an awkward position due to confidentiality rights of clients.

A client must sign a release of information in order for a therapist to release information. Best practice would be to tell the client, up front, that the only time the therapist would be forced to release information without consent is if there is “clear and convincing evidence regarding harm to self or others.”

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

- Plaut, S. M., Brown, J. K., Brancu, M., Wilbur, R. C., & 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.

Documenting Domestic Violence: How Health Care Providers Can Help Victims

- Isaac, N. E. & Enos, V. P. (2001). Documenting Domestic Violence: How Health Care Providers Can Help Victims. U.S. Department of Justice.
The article above contains foundational information. Articles below contain optional updates.

Personal Reflection Exercise #4
The preceding section contained information on ethically setting boundaries with victims of domestic violence. Write three case study examples regarding how you might use the content of this section of the Manual in your practice.

QUESTION 12
What are two consequences therapists have to consider when reporting domestic violence? To select and enter your answer go to Ethics CE Test.