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Setting Clear and Ethical Boundaries with Clients

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Additional Reading

Excerpt from Vandenberghe, Luc. "Keeping the focus on clinically relevant behavior: supervision for functional analytic psychotherapy." The International Journal of Behavioral Consultation and Therapy 5.2 (2009): 209+. Academic OneFile. Web. 29 Mar. 2010.

Conclusion.

One suggestion for the first context is the use of specific types of instructions. Instructions that select actions leading to natural reinforcement for the therapist in-session are to be preferred. When a therapist obtains sufficiently reinforcing effects in-session while following through with supervisor instructions, this will lead to increased control by in-session contingencies over the therapist's behavior. In other words, he or she will continue using the instructed skills, not because of the supervisor's control over his or her rule -following, but because these skills work for him or her in-session. How can the supervisor predict if selected instructions will help the therapist to contact natural reinforcement? Information about both the supervisee and the client is needed for such a decision. For instance, the supervisor can provide the therapist with instructions for actions that are well within his or her technical reach, and which will yield immediate results with the client, given what the supervisor knows about the client. An example might be asking an affectionate therapist to increase closeness in response to in-vivo improvements of a client who finds closeness desirable.

Another specific class of instructions the supervisor may use in the first context is a category we call incomplete instructions. The supervisor does not state the entire action to be undertaken by the therapist. The latter will need to complete the instructions with information to be identified in-session. As an example, the supervisor can instruct the therapist to give the client feedback about behaviors that may help solve the problem for which she sought treatment. To make this instruction workable, the therapist will need to think the client case conceptualization over and engage in keen observation of what is happening in the relationship.

Alternatively, the supervisor can avoid using instructions and instead ask direct questions that prompt the therapist to stay closely attuned to the client's behavior. An example would be to ask the therapist what in-session behaviors he or she imagines the client may also emit in the relationships where the client's daily life problems are most salient. Therapists then learn to make theirinterventions on the basis of the answers they find to these questions.

A related technique that can be used in this context is having the therapist label the effects the client has on him or her. The supervisor may, for instance, ask frequent questions about what the therapist is feeling in-session with the client. Such questions will make the therapist focus on those client behaviors that have interpersonal impact. And these are most frequently the client problem or target behaviors. In answering such questions, the therapist learns to monitor his or her feelings towards the client. As a result, the therapist's sensitivity to promising in-vivo learning opportunities as well as his or her awareness of subtle client improvements will increase.

 


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