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Setting Clear and Ethical Boundaries with Clients

Section 6
Conflict of Interest

Question 6 | Test | Table of Contents

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Let's look at how the friendship/partnership boundary becomes blurred in creating a conflict of interest in a session.

A partnership refers to an association between you and your client in which each understands the role and tasks of the other. The therapeutic partnership is based on an understanding and acceptance of the differences of the roles and tasks of your client and you. However, the fine line of a therapeutic conflict-of-interest gets crossed when this partnership blurs into a friendship.

♦ Case Study: Sue and Brenda
Here is an experience one of my colleagues, Sue, had, that shows how easily this can occur. Sue was co-leading a Monday Support Group for women that met one evening a week. The other co-leader, Brenda, was in private practice and met clients at her home-office. After one of the regular women's group meetings at Brenda's home-office, Sue returned an hour after the meeting had adjourned to pick up her forgotten coat.

Sue was surprised to find Brenda's town house filled with 10 to 15 women, most of which had attended the earlier group. Two members of the group were topless and giving each other massages. Apparently Brenda's daughter's friends included members of the Brenda's Monday Support Group. Brenda had decided to host a get-together for her daughter and her daughter's friends. .

Wow, talk about a blur in boundaries between professional relationships and friendships! After the next group meeting, Sue mentioned her concerns regarding dual relationships and the effect upon the therapy relationship, as well as how Brenda was leaving herself open for possible claims of sexual abuse or harassment. She clearly was so enmeshed in the dual roles between therapist and being a friend and mother to her daughter, Brenda saw no reason to change. Sue felt uncomfortable with her involvement with the group and discontinued co-leadership.

♦ Friendship vs. Partnership
If you find yourself meeting your own personal needs for friendship in relationships with clients, do you need to reconsider how to restore a therapeutic boundary to eliminate this conflict of interest in the relationship in order to facilitate your decision regarding the ethics of a possible friendship with a client? If you have friendship versus therapeutic relationship conflicts, ask yourself, "What is the context of my situation? What are my client's goals? Is there a potential for harm?"

In my opinion, the context of the party that included clients giving partially nude massages definitely violated an ethic boundary. And since some of the clients were struggling with relationship goals, I feel this personal situation might cause certain clients to be less open in the group, thus hindering their possible growth. Lastly, the potential harm could come in many forms, including and not limited to a violation of the sexual abuse boundary.

Peer-Reviewed Journal Article References:
Geller, S. M., & Porges, S. W. (2014). Therapeutic presence: Neurophysiological mechanisms mediating feeling safe in therapeutic relationships. Journal of Psychotherapy Integration, 24(3), 178–192.

Pinner, D. H., & Kivlighan, D. M. III. (2018). The ethical implications and utility of routine outcome monitoring in determining boundaries of competence in practice. Professional Psychology: Research and Practice, 49(4), 247–254.

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. 

Schwartz, R. A., Chambless, D. L., Milrod, B., & Barber, J. P. (2021). Patient, therapist, and relational antecedents of hostile resistance in cognitive–behavioral therapy for panic disorder: A qualitative investigation. Psychotherapy, 58(2), 230–241.

Summers, F. (2017). Sexual relationships between patient and therapist: Boundary violation or collapse of the therapeutic space? Psychoanalytic Psychology, 34(2), 175–181. 

A therapeutic partnership is based on understanding and acceptance of the differences in roles and tasks between therapist and client. Thus, the partnership is not to be confused with what? To select and enter your answer go to Test.

Section 7
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