Counselor Ethical Boundaries and Practices
Boundaries are essential in the establishment of any effective counselor-client relationship as they provide a consistent structure and framework for the counseling process. However, several complaints have arisen in the present society concerning unethical client-counselor boundaries and relationships. The complaints compounded by the complex nature of modern ethical boundaries and dual relationships have resulted in the contemporary practice of psychology being regulated than ever before. The complex nature of modern psychology practice requires counselors to have a high moral and legal standing in their relations with clients. Through formally established codes of conduct, the practice of psychology is regulated to ensure that both moral and ethical malpractice and complaints are minimized. In the modern practice of psychology, counselors have to maintain ethical boundaries and relationships in their interactions not only with their clients but also with their professional colleagues.
Boundary Issues and Dual Relationships
In the practice of psychology, the concept of boundaries is essential as it affects not only the quality of client care but also the morality and legality of the profession in general. Counseling cannot be done without the creation of counselor-client boundaries that set the structure for the relationship of the two and provide a consistent framework upon which the counseling process is based (Zur, n.d.). Boundaries are ethical guidelines that limit the actions of the counselor and are based on the basic principles of the psychologists’ code of ethics. Boundary crossings occur when there are dual relationships between the counselor and client or the issue of conflict of interests arises in the counseling process (Krishnaram, Aravind, & Thasneem, 2012). Boundary crossings in the practice of psychology severely impact client care and can result in severe mental damage to a client if not appropriately dealt with by the counselor (Hanna & Suplee, 2012). The American Counselling Association (ACA) Code of Ethics provides various rules that regulate the issue of boundary crossings and can be used by counselors to determine whether a relationship is ethical or not.
The ACA Code of ethics provides counselors with a framework of establishing ethical boundaries and criteria for determining unethical boundary crossings. Unethical boundary crossings mostly occur when professional relationships are combined with non-professional relationships to create a dual relationship (Hanna & Suplee, 2012). For example, a counselor engaging in a professional counseling relationship with his divorced partner is likely to raise ethical questions. Dual relationships are unethical as they result in impaired objectivity and undermine the professional relationship that should exist between a counselor and client (Nancarrow et al., 2013). Examples of unethical boundary crossings according to the ACA Code of ethics include; violations, non-sexual, or sexual crossings (ACA, 2014). The ACA Code of ethics comes in handy in the determination of whether a relationship between a counselor and client is both moral and legal or not. Before, coming to a final decision as to the morality of a counselor-client relationship, a counselor needs to analyze the particulars of the specific case he or she is handling. Based on the analysis, the counselor should apply the code of ethics provided by ACA and also consult with his or her supervisor before making a final decision.
Below are examples of how the above criteria for determining dual relationships can be implemented in practical psychology situations:
Boundary crossings can occur between a client and a counselor during the counseling process without the express knowledge of both parties. For example, through sheer physical fascination, a dual relationship may exist between a client and counselor. According to the ACA code of ethics, it is the primary obligation of the counselor to prevent any boundary crossing from happening (ACA, 2014). However, in the eventuality that a dual relationship is formed during the counseling process, the counselor must take the necessary steps to rectify the unethical practice. First, the counselor should analyze the particulars of the case he or she is handling and if possible, recuse himself from the counseling process. If the counselor cannot withdraw from the case, he or she should seek the advice of a supervisor of a superior officer. Upon the chance that the counselor can control his or her emotions, the counseling process can continue, albeit, under the guidance of a supervisor. Another example of boundary-crossing can take the form of communal dual relationships. Communal dual relationships occur where both the client and counselor live in a small area and are deemed to meet frequently outside the professional confines of mental health practice (Nancarrow et al., 2013). In this case, before the start of any professional mental care practice, both the counselor and the client should state in the informed consent that they are not obliged to initiate any form of communication in their future public meetings (Nancarrow et al., 2013). This ensures that the professional relationship between the two is not adulterated by their public or private lives.
The third case example is where a counselor is romantically involved with the relations of his or her client. This is quite a complex relationship and the counselor has to take care not to engage in any unethical practice or conduct during the counseling process. In this case, the principles of patient confidentiality and integrity are to be upheld by the counselor to the highest standards possible, if he or she is to continue providing mental care to the client (Nancarrow et al., 2013). On the other hand, the counselor can recuse himself or herself from the case altogether. In a case where a counselor is attracted to the client, he or she is required to acknowledge his emotions and take appropriate steps to deal with them. The best solution, in this case, would be to reassign the case to another counselor. A counselor is not legally and morally allowed to act on his emotions and create a romantic relationship with his or her client (Hanna & Suplee, 2012). The provisions of the ACA (2014), also provides that a counselor cannot offer any mental health care to individuals they previously had romantic or sexual relations with.
Professional Collaboration in Counseling: Working with A Multi-Disciplinary Team
In contemporary psychology practice, co-operation and collaboration are key to the provision of quality mental health care. Collaboration with different experts in the field of mental health care enables patients to get comprehensive psychological care which is essential in the treatment of various mental illnesses (Hanna & Suplee, 2012). For an effective and efficient professional collaboration process, a multi-disciplinary framework should be created and used as the basis of guiding an interdisciplinary team. The success of an inter-disciplinary professional team is based on the principles of collaboration, compromise, and similar objectives (Hanna & Suplee, 2012). Professional counselors should collaborate and create a supportive group atmosphere where each person’s opinion is heard. Compromise enables different team members to debate on divergent approaches and concepts and come up with the best solution. Compromise is essential in maintaining the unity of a multi-disciplinary team of psychologists. The operations of the team should also be regulated by proper evidence-based practices and patient outcomes to ensure that they are both ethical and legal. Lastly, no team can be created without the members being united by similar goals and objectives. A team of psychologists has to come up with a similar overriding goal to guide the operations of their multi-disciplinary team. An objective based on the provision of proper mental care ensures that the team members contribute in divergent ways to provide the best psychological care to their clients.
Numerous expectations come with being part and parcel of a professional multi-disciplinary team. A multi-disciplinary team is normally made up of several professional practitioners under the guidance of a supervisor. The supervisor ensures the efficient and smooth flow of the team operations and chips in to offer guidance and expertise whenever needed. The members of the team, the counselors, are involved in the actual day to day activities of providing mental health care to their patients (Kurpad et al., 2012). The multi-disciplinary team approach enables practitioners to collaborate in their work to better serve their clients. A multi-disciplinary team of professionals is also characterized by several issues more so appertaining to disputes within the group. The ACA code of practice which advocates for collaboration also provides guidelines on how inter-team disputes can be resolved. According to provisions of the ACA Code of ethics 2014, supervisors cannot hassle or demean in any manner practitioners who abide by the ethical rules of practice (ACA, 2014). The provisions of Section D of the ACA Code of ethics enables professionals to smoothly resolve disputes that occur in their multi-disciplinary teams.
Relationships with Supervisors and Colleagues
Apart from the client-counselor relationships, psychology practitioners also have to maintain a healthy relationship with their supervisors. The main role of supervisors is to monitor the dispensation of quality client care and the operations of the counselors in the counseling process. Supervisors ensure that mental health practitioners abide by the ACA Code of ethics in their counseling activities. Clinical supervisors ensure that counselors are well versed with the provisions of the ACA code of ethics and implement them in their actions (ACA, 2014). Supervisors also support counselors in their work by giving them additional insight, advice, and training. Medical supervisors are generally more experienced than the average counselors and mentor mental health practitioners. Medical supervisors also ensure that effective and efficient co-operation and collaboration take place among the counselors for the provision of better mental care to patients.
Ethical issues also arise in the relationships between supervisors and counselors. The relationship between supervisors and counselors is required to be professional at all times to avoid a lack of objectivity in the dispensation of mental care (Hanna & Suplee, 2012). However, similar to the counselor-client relationship several unethical issues arise in the counselor-client relationship. For example, the physical attraction between a supervisor and a counselor can exist and this risk the professional relationship of the two being affected by personal issues. Ethical issues involved in the supervisor-counselor relationship, unlike that of the counselor-client, though immoral, does not directly affect the mental health of patients. Moreover, counselors can also observe unethical behavior in their colleagues. For example, a counselor may observe his or her colleague developing a romantic relationship with a client. According to the provisions of the ACA code of ethics, such a counselor should report the matter to a competent supervisor (ACA, 2014). The supervisor is then obliged to investigate the unethical conduct and refer it to the licensing board if he or she concludes that the counselor acted immorally. The licensing board is regulated by the ACA code of ethics to revoke the license of any unscrupulous practitioner.
Thoughts Regarding Ethics
My knowledge of ethics and its relationship with the practice of psychology has improved immensely in the course of my study during this course. Ethics are essential in regulating the conduct of professionals not only towards their clients but also their supervisors and colleagues. I have also learned the essence of relationships in the practice of mental health care and how they can be easily abused. Moreover, I have come to understand the thin line that separates the ethical from the unethical and how I can distinguish the two in my future practice. Throughout this course, I have come to fully understand the importance of teamwork and supervision more so in complex filed such as that of mental health.
Conclusion
Ethical practice is the cornerstone of mental health care. Without proper ethical rules, many counselors cannot provide proper and objective interventions to their clients. The gray area between ethical boundaries and dual relationships is at the core of counseling thus very delicate in matters of mental health care. The ACA Code of ethics provides a guideline not only in the area of practice but also in matters of professional co-operation and collaborations. This makes the ACA code of ethics a big step forward in the dispensation of quality mental health in America.
References
American Counseling Association. (2014). ACA code of ethics. Retrieved from https://www.counseling.org/resources/aca-code-of-ethics.pdf
Hanna, A. F., & Suplee, P. D. (2012). Don’t cross the line: Respecting professional boundaries. Nursing2019, 42(9), 40-47. https://doi.org/10.1097/01.NURSE.0000418612.68723.54
Krishnaram, V., Aravind, V., & Thasneem, Z. (2012). Boundary crossings and violations in clinical settings. Indian Journal of Psychological Medicine, 34(1), 21-24. https://doi.org/10.4103/0253-7176.96151
Kurpad, S., Machado, T., Galgali, R., & Daniel, S. (2012). All about elephants in rooms and dogs that do not bark in the night: Boundary violations and the health professional in India. Indian Journal of Psychiatry, 54(1), 81-87. https://doi.org/10.4103/0019-5545.94654
Nancarrow, S. A., Booth, A., Ariss, S., Smith, T., Enderby, P., & Roots, A. (2013). Ten principles of good interdisciplinary teamwork. Human Resources for Health, 11(1), 2-11. https://doi.org/10.1186/1478-4491-11-19
Zur, O. (n.d.). Dual relationships, multiple relationships, boundaries, boundary crossings, & boundary violations in psychotherapy, counseling & mental health. Retrieved from https://www.zurinstitute.com/dualrelationships.html
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