Let's 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 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
Take 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
A 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 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.
Here's an example of how I use partialization related to a crisis situation in such a way as to minimize conflicts of interest 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, 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 - In extreme 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 crisis 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.
Peer-Reviewed Journal Article References:
Drum, K. B., & Littleton, H. L. (2014). Therapeutic boundaries in telepsychology: Unique issues and best practice recommendations. Professional Psychology: Research and Practice, 45(5), 309–315.
Pachter, W. S., Fox, R. E., Zimbardo, P., & Antonuccio, D. O. (2007). Corporate funding and conflicts of interest: A primer for psychologists. American Psychologist, 62(9), 1005–1015.
Sah, S., & Feiler, D. (2020). Conflict of interest disclosure with high-quality advice: The disclosure penalty and the altruistic signal. Psychology, Public Policy, and Law, 26(1), 88–104.
Twohig, M. P., Ong, C. W., Krafft, J., Barney, J. L., & Levin, M. E. (2019). Starting off on the right foot in acceptance and commitment therapy. Psychotherapy, 56(1), 16–20.
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.
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