Clinician Care: Maintaining Boundaries
Maintaining Therapist-Client Boundaries: Minimizing the Risk of Dual Relationships
Within home-based therapy, unintentionally creating a dual-relationship with your clients is a possibility; particularly for therapists living in a rural area and serving clients in that same area. Many ethical decisions you make are governed by internal values, principles, or obligations and legal statutes, professional codes of conduct, and regulating boards (Schank & Skovholt, 1997). If you are working in a small community, it may be your ethical responsibility to serve an individual you already know because of the lack of other services available (Schank & Skovholt, 1997). If you are working in a more urban area, this risk of serving someone you already know is decreased and can often be avoided. As a home-based therapist, there are some precautions you can take to avoid problematic dual-relationships that can be used for both rural and urban scenarios.
It is important to remember that a dual relationship is not always a problem as long as the client's welfare is not compromised (Schank & Skovholt, 1997). A dilemma that you may face is deciding whom to see as a client when evaluating boundary issues. Some dilemmas that you may face as a therapist is the reality of overlapping social, business and professional relationships, and the overlapping of relationships of clients and members of your family (Schank & Skovholt, 1997). In Schank & Skovholt's (1997) study of rural and small community psychologists, the participants used three different criteria to help him/her make decisions on whom to see as clients: a). the decision was made on the basis of the psychologist's own comfort level of whether he/she could successfully manage the dual relationship, b). some psychologists involved the prospective client in the decision-making process, and c). some clinicians assessed the type and severity of the clients' presenting problem to determine if they could manage the dual relationship.
Schank & Skovholt (1997) have provided some ways to minimize the risk of dual-relationships within your therapeutic career.
- Always be aware of your profession's and state's specific ethical codes and regulations regarding client contact and dual relationships.
- Provide your clients with clear expectations and boundaries whenever possible. This also can strengthen the therapeutic relationship and is especially important if you will most likely come in contact with your clients in public. Remember to always obtain informed consent, stick to the alloted therapy time, protect client confidentiality, and document, document, document!
- As a home-based therapist, it is especially important that you remember to consult with other professionals and/or supervisors to discuss cases that you may be concerned involve a dual relationship. Colleagues can often provide you insight into dilemmas you are blind to.
- Maintaining self-care and a life outside of your work will decrease the risk of conflictual dual relationships. By always being aware of client-therapist boundaries, you will be taking care of yourself both professionally and personally.