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Four Boundary Questions
The following are four values that constitute a basic premise of the therapeutic
relationship. Let's look at how even the most basic of concepts present boundary
questions. Here is an example of each of the four values:
worth of the individual. A basic premise right? Think again. Who determines how
worthy someone is to retain custody of his or her children? When you write your
recommendations to the court, what was the boundary or limit you set in your report
regarding the intensity and frequency of abuse for the "rehabilitated"
parents seeking to regain custody?
#2.The right of self-determination is also a basic ethical premise that raises
boundary issues. Later on this CD we will explore the issue of suicide. However,
with a suicidal client you treated, where did you set the boundary between freedom
and commitment to an in-patient unit?
#3.A thirdphilosophical basis of the therapeutic relationship is the right to share
the benefits of society, but at what point does your client with a substance-related
disorder lose his rights to share the benefits of society? Let's explore this
one further. Some substance-use treatment professionals have criticized the classification
of substance-use disorders by the DSM, Diagnostic and Statistical Manual, as simplistic
and too straightforward.
They have argued that substance use cannot be forced
into the two arbitrary categories of abuse or dependence, but rather that substance
use represents a continuum that ranges from non-use to dependency. With your last
"substance-related disordered client," what criteria did you use to
set a boundary in the gray area of the DSM classification system, which many view
as inadequate, regarding court orders to a treatment facility and depriving the
client of his or her right to benefit from societal freedom?
#4. The mutual rights and responsibility between your client and society is a philosophical
basis of the mental health professions. Now, regarding the boundary between rights
of your client, versus the rights of society...ask yourself...the last time your
client threatened to harm an identifiable other, where and how in your mind did
you draw the limit regarding a need to warn or not warn the other party?
The point to be made here is that, even in the most basic of premises regarding
our mental health profession you are drawing ethical boundaries.
Four Basic Ethics Premises Examples
the preceding examples, select one which is most meaningful. Here are the four
basic premises examples again: 1. Your recommendations to the court
for treatment decisions about custody in a child abuse case; 2. Suicide and commitment; 3. Substance abuse; and 4. Duty-to-warn regarding
threats to an identifiable other. Ask yourself how do I set boundaries with
this difficult issue?
Strategy for Setting Boundaries Effectively with Clients
It has been my experience that I set boundaries
effectively with clients when I feel I am able to gain personal objectivity. How
do I gain this objectivity? By increasing my personal awareness regarding my needs,
weaknesses, and strengths.
"awareness" I mean my ability to deal with my personality patterns and
client issues, as they may relate to my life experience, which may cloud my ability
to relate to the client.
I look at my level of openness. I look at my
ability to be aware of values, attitudes, and patterns of behaving in the groups
of which I consider to be a part. Lastly, I look at my ability to differ and stand
alone when necessary should I need to act as an advocate for the client.
It is one thing to recognize my shortcomings and another to change them.
4 Factors for Rating Your Ability to be Ethically Comfortable
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have explored your attitudes and how they are linked to learned behaviors and
Now let's increase your self awareness of the impact of your personalneeds in light of defense mechanisms, security versus growth, and middle-class
Ethics - Defense Mechanisms
defense mechanisms, the nature of life's demands are such that there are times
when it is constructive to make temporary use of defense mechanisms like denial,
projection, regression, fantasy, and so on. As you know, this helps us to guard
against anxiety and pain that would otherwise be overwhelming.
For example, I
treated a client, Jane, who used denial as a reaction to her husband's physical
abuse. Only when it extended to her daughter was Jane able to overcome her fear,
face reality, and make use of help and resources.
you know, you need to be able to recognize the presence of defense mechanisms
both in yourself and in your clients. Ask yourself whether your uses of defenses
are constructive or destructive, whether consciously or unconsciously aware
at the time. As you know, your selection of a particular defense mechanism is
strongly influenced by your background.
For example, do you have a family member
that uses humor to deal with painfulfeelings? If not, what coping mechanisms
did your family use...denial? projection? regression? Think for a minute when
a client uses these mechanisms, do you become uncomfortable because they mirror
your issues? Do you need to more consciously set a boundary between your feelings
about a client's use of a defense mechanism and the ones you employ?
Learning to Use Yourself More Effectively
assist with this process of learning to know and use yourself more effectively
related to your awareness of setting ethical boundaries with your clients, ask
yourself the following questions:
5 Questions to Know Yourself
-- 1. How do I think and feel about myself? Answer
in one word or a short phrase. -- 2. What is my self image? -- 3. Do I feel I am physically or intellectually
handicapped in some area or do I feel I am whole? -- 4. Do I see myself as old, middle-aged,
-- 5. Am I fat, thin, or average?
I feel one of the most important factors
in self awareness, and thus in setting ethical boundaries with clients, is how
you feel about yourself. I know when I feel I like myself, I feel I usually relate
in a more open, receptive manner to my clients. Let's explore this further.
4 Ethics Factors in Rating Your Ability to be Ethically Comfortable with Yourself
to Brems, in "Dealing with Challenges in Psychotherapy and Counseling,"
Your ability to be comfortable with yourself is based on the following four
Factor #1.Awareness of and ability to accept yourself as a fallible
person and therapist with strengths and weaknesses. We have already covered cultural
role expectations placed upon males being the "white knight," so to
speak and having all of the answers, and females to being submissive. How are
you at self acceptance?
Factor #2.Development of a flexible adaptive
pattern that does not demand perfection of yourself and hence does not expect
it of others. We as therapists always strive to accept our lack of perfection,
but where are you right now as you listen to this CD? Rate yourself, on a scale
from 1 to 10. One is low, being a total lack of your imperfection, and 10 is high,
being a total acceptance of your imperfections.
Factor #3.Regarding your
ability to be comfortable with yourself, how would you rate your capacity to recognize
and deal with the impact of negative attitudes? Are you a female who feels discriminated against regarding the last promotion or special privilege handed out to a male
in your agency? Or are you male, who feels he is the victim of reverse-discrimination?
Factor #4.Acceptance of the fact that self-liking is not static or unchanging. Self acceptance and liking involves a continuous process of awareness, assessment,
point to be made here is, setting ethical boundaries with clients begins with
your comfortlevel with yourself as a basis for making objective treatment decisions.
- Brems, C. (2000). Dealing with Challenges in Psychotherapy and Counseling. New York: Brooks and Cloe.
Preventing Child Sexual Abuse Within Youth-serving Organizations:
Getting Started on Policies and Procedures
- Saul J, Audage NC. Preventing Child Sexual Abuse Within Youth-serving Organizations: Getting Started on Policies and Procedures. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2007.
Ethics CEU QUESTION
6 Your ability to be comfortable with yourself is based on what four factors? To
select and enter your answer go to Ethics CEU Answer Booklet.
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