Module 5 Flashcards
(75 cards)
1
Q
When does a dual relationship occur?
A
- When psych engages in another significant, meaningful relationship with the client in addition to the professional relationship.
- May occur simultaneously with, or after the termination of, the professional relationship.
2
Q
What are 4 types of multiple relationships?
A
- Non-professional relationship with client (friend, family member)
- Different professional relationship with the client (work colleague, tenant)
- Non-professional relationship with associated party (client’s best friend, sibling)
- Recipient of service provided by client (client is also your GP, psychologist, or masseuse etc.)
3
Q
What are 3 problems associated with MRs?
A
- Unequal power relationship (client vulnerability / potentially exploitative or harmful)
- Conflict of interest
- Objectivity may be compromised
4
Q
Why can the term ‘relationship’ be confusing with regarding MR’s?
A
- Incidental or accidental contacts (unintended or brief interactions with a client outside of the therapy context); and,
- Boundary crossings (benign, constructive interactions with a client that cross the traditional external boundaries that frame the therapeutic relationship)
5
Q
What’s the difference between boundary crossing and entering a MR with a client?
A
Boundary crossings become behaviours in a MR when the professional assumes another role in another relationship with the client
6
Q
What are 3 examples of boundary crossing?
A
- Crying in front of a client
- Attending a client’s special event
- Disclosing a personal stressor to a client
7
Q
List some types of boundaries
A
Role Time Place and Space Money Gifts Services Clothing Language Self-disclosure Physical contact
8
Q
How much does the purist and psychoanalyst disclose?
A
Nothing
9
Q
If you were to enter into another relationship with a client, what are 3 things you should do before-hand?
A
- Be aware of client vulnerability and the potential for exploitation
- Conflict of interest - develop a plan to minimise harm
- Ensure your objectivity is not compromised
10
Q
Are boundary crossings unethical?
A
Not necessarily however can lead to boundary violations (unethical)
11
Q
What has blurring of boundaries been considered a precursor to?
A
Later major transgressions (i.e. boundary violations).
12
Q
Give on example of how a boundary crossing can quickly turn into a boundary violation
A
Doing a home visit for an elderly person (acceptable boundary crossing), but then staying for dinner (boundary violation)
13
Q
How might unavoidable MR’s be dealt with in therapy?
A
Informed consent at beginning of session
14
Q
What is a boundary crossing?
A
Departures from commonly accepted practice; descriptive term (neither laudatory nor perjorative)
15
Q
What is a boundary violation?
A
Major transgressions ( to the client’s disadvantage)
16
Q
What did Gottlieb and Younggren (2009) report regarding the frequency with which minor boundary crossings lead to a major boundary violation?
A
Exaggerated. They suggest the slope is less steep and less slippery for most practitioners.
17
Q
Gottlieb and Younggren (2009): Why was the terminology changed from ‘dual relationships’ to ‘multiple relationships’?
A
More accurately reflected the complexity of contemporary practice by emphasising that practitioners could have a variety of relationships with the same client
18
Q
Gottlieb and Younggren (2009): What was Guntheil & Gabbard’s notion of the slippery slope? (contested by G & Y, authors)
A
Gradual process, abstracted from physics in which sexual acts where preceeding by a series of boundary crossings that did not have negative results per se; rather each had a desensitising effect that made the next boundary crossing easier
Implied that the practitioner was unaware and that at some point the momentum of previous boundary crossings would force the practitioner into a boundary violation.
19
Q
Gottlieb and Younggren (2009): What are the 2 components of Berry’s model?
A
- Maintenence - degree to which student the ethical and value traditions of their culture of origin
- Contact and participation - degree to which students adopted the norms and values of their new professional culture
20
Q
Gottlieb and Younggren (2009): What happens if students are high on both maintenence and contact & participation?
A
They use an ‘integration strategy’
Best possible choice - students can incorporate ethical values of psychology and maintain their personal values.
21
Q
(Gottlieb and Younggren): What are the 4 strategies of ethical acculturation? Which is most likely to lead one down the slippery slope of boundary crossing?
A
- Integration (high maintenance of personal values, high contact/participation with new culture of psychology)
- Separation (high maintenance, low contact, more likely to make decisions based on personal values
- Assimilation (low maintenance, high contact)
- Marginalisation (low maintenance, low contact, most likely to go down slippery slope)
22
Q
(Gottlieb and Younggren): How might someone using ‘separation’ strategy behave?
A
May be more likely to make professional decisions based on personal values, believing they do not need additional rules to govern their professional behaviour.
23
Q
(Gottlieb and Younggren): Is someone using the ‘separation’ strategy likely to commit boundary violation ?
A
Unlikely due to strong personal cultural values
24
Q
(Gottlieb and Younggren): What does ‘assimilation’ refer to?
A
Low maintenance, high contact
Refers to overidentification with professional standards to the extent that that practitioners may lose many of their own personal values.
In effort to develop professional identities, students may divorce themselves from personal values in the belief they are no longer necessary.
25
(Gottlieb and Younggren): How do those adopting a assimilation strategy behave?
Demonstrate literal compliance with rules and laws but lack a moral foundation that may lead them to overly simplistic applications of ethical principles
26
(Gottlieb and Younggren): Is someone operating under assimilation strategy likely to commit boundary violation?
Unlikely - although more likely than integration or separation
27
(Gottlieb and Younggren): What does 'marginalisation' strategy refer to?
Most problematic alternative
Low identification with personal values and professional culture
28
(Gottlieb and Younggren): Which strategy do most psychologists adopt?
Integration
29
(Gottlieb and Younggren): What are the two areas of scholarship that augment our thinking regarding the slippery slope?
Positive ethics
Intuitive process & self-serving bias (negative)
30
(Gottlieb and Younggren): What is the EAM?
Ethics Acculturation Model
31
(Gottlieb and Younggren): Regarding Bloom's Taxonomy, risk is a function of which four factors?
1. Patient characteristics
2. Context or setting
3. Potential disciplinary consequences
4. Psychotherapist factors
32
What are the 6 levels of Bloom's taxonomy?
1. Knowledge, entailing remembering learned info that was largely memorised
2. Comprehesion; requiring learners to translate material from one for or another, or explain and summarise it
3. Application - ability to use learned info in specific situations
4. Analysis - ability to break down material into it's components for better understanding
5. Synthesis - ability to combine info to create meaningful structures
6. Evaluation - ability to judge the value of a given response ie should be able to provide reasonsbehind a decision
33
What were some of Gottlieb and Younggren's recommendations for avoiding the slippery slope?
1. Comprehensive informed consent document
2. Peer consultation groups (encourage intergration strategy)
3. Document consultants' suggestions
4. Develop your own set of practice ethics policies
5. More research
6. Professional competence in multicultural context
7. Positive ethics
8. Self-care and care for colleagues
34
Gottlieb and Younggren's stance on the slippery slope?
It exists but it's neither as steep or as slippery as we might fear
35
What are the 9 steps Pope and Kieth-Spiegel (2008) recommend for considering whether a boundary crossing is helpful or harmful?
1. Imagine the best and worst possible outcomes
2. Look at the research
3. Look at guidelines, ethics codes, laws
4. Pay attention to your own feelings
5. Inform the client about the exact kind of work you do.
6. Refer on if client appears uncomfortable
7. Refer on if you feel incompetent
8. Put any planned boundary crossings in informed consent
9. Keep notes
36
What are the 7 cognitive errors identified by Pope and Kieth-Spiegel (2008)?
1. What happens outside the session has nothing to do with therapy
2. Crossing a boundary with a client is the same as doing that with a non-client (eg: helping them take off their coat)
3. Our understanding of a boundary crossing is also the client's understanding of a boundary crossing
4. A boundary crossing that is therapeutic for one client will also be therapeutic for another
5. A boundary crossing is a static, isolated event
6. If we don't see any downsides to crossing a boundary, then there aren't any
7. Self-disclosure is always therapeutic, because it shows authenticity, transparency, and trust
37
Pope & Keith-Spiegel: What are a few of the most basic assumptions they make about ethical awareness and decision making?
1. Ethical awareness is a continuous, active process
2. Awareness of ethical codes and legal standards is an essential aspect of critical thinking about ethics
3. Awareness of the evolving research and theory however must greet published claims and conclusions with active, careful, questioning
4. All of us can—and do—sometimes make
mistakes about boundary decisions and any other aspect of our work. An important part of our work is questioning ourselves
5. Many of us find it easier to question the ethics of others, while putting our own beliefs, assumptions, and actions off-limits
6. Many of us find it easier and more natural to question ourselves in areas where we are uncertain. It tends to be much harder, but often much more productive, to
question ourselves about what we are most sure of.
7. As psychotherapists, we often encounter ethical dilemmas without clear and easy answers
8. Consultation generally helpful and sometimes crucial
38
What are the two ethical traps that apply to the therapist factors when making a decision about boundary crossing?
1. Commonsense, objectivity trap - a belief that commonsense, objective solutions to professional ethical dilemmas are easy
2. Values trap - personal values (morals, religion) in conflict with requirements specified by professional code
39
What are the 4 factors of Sonne's model?
1. Therapist factors
2. Client factors
3. Therapy relationship factors
4. Other relationship factors
40
What are some therapist factors that may contribute to boundary crossings?
- Ethical sensitivity (first step in ethical decision making process)
- Willingness to expend cognitive effort
- Guiding ethical principles
- Gender - men tend to take more risks
- Culture
- Religion/spirituality
- Theoretical orientation (eg: humanists have more MRs)
- Character traits (eg: need to please)
41
What are some client factors that may contribute to boundary crossings?
- Gender
- Culture
- Religion/spirituality
- Psychosocial strengths/vulnerabilities (eg: not crossing boundaries with BPD clients)
- History of boundary crossings (eg: sexual assault victims)
42
What are some therapy-relationship factors that may contribute to boundary crossings?
- Nature of therapeutic relationship (eg: informed consent, transference)
- Power differential (greater = more risk to client)
- Duration of therapy
- Practice setting
- Practice locale (small/specialised communities at higher risk of MRs)
43
What are some other relationship factors that may contribute to boundary crossings?
- Change in nature of relationship
- Who's needs are being met?
- Potential for role conflict/incompatibility
- Potential for harm to client/third parties
- Potential for client benefit
44
According to Sonne, what are 2 reasons for the inaccuracies in our thinking around nonsexual multiple relationships?
1. The term 'nonsexual multiple relationship' is confused with incidental/accidental contacts, and boundary crossings
2. The topic of nonsexual multiple relationships arouses uneasiness
45
Are dual relationships common in China?
Yes
46
What is the concept of Renqing?
Human relationship and mutuality.
Renqing informs the normative behaviour of fostering interpersonal relationships. Hence, in China, clients seek to establish a close relationship (i.e., the ‘insider’ or ‘you’re one of us’) with the psychologist.
47
What are some strategies for when multiple MRs cannot be avoided?
- Set clear boundaries
- Obtain informed consent
- Seek consultation, get more objective perspective
- Document practices
- Ask yourself whether the benefits of the MR outweigh the harms
- Self-monitor
- who's needs are being met by maintaining the MR?
48
According to Pope and Keith-Spiegel (2008), what are 9 steps you can implement if a boundary crossing goes wrong?
1. Monitor the situation carefully
2. Be open and non-defensive
3. Consult
4. Listen to the client
5. See it from the client's point of view
6. Look at research
7. Keep records
8. Consider apologising
9. Apologise if need be
49
Which part of the APS Code of Ethics does boundary issues and multiple relationships full under?
A: Respect
50
According to the APS Guidelines, what are major boundary violations often preceded by?
Lack of attention to minor boundary crossings
51
What section does Conflict of Interest fall under in the code?
C - Integrity
52
According to the CoE (2007), when entering into multiple relationship is necessary, what should the psych do?
- Adhere to A.3 - Informed Consent
- Seek consultation
- Potentially discontinue service
53
What are 4 work settings that have a higher incidence of boundary crossings?
- Individual practice
- Home offices
- Practices in small (eg: rural or ethnic) communities
- Consulting to organisations
54
What's the main problem with going into business with current or former clients?
Conflict of interest
55
What's the main problem with providing psychological services to family and friends?
Objectivity is compromised -> judgement likely to be impaired
56
What should psychologists consider regarding interactions with former clients?
- the extent to which an equal relationship can be established
- whether client is dependent of psychologist
- whether former client may want to re-establish professional relationship in future
57
What are the 3 most commonly requested secrets from clients in couples therapy?
- Extra-relational affair
- Wanting a divorce
- Internet infidelity/chatting
58
What should a psych do at the beginning of working with couples / groups?
Advise all clients of policies regarding confidential communication and working with multiple parties.
Should be considered a routine component of the informed consent process and included in signed consent forms.
59
What are some challenging ethical issues that arise when working with families?
- Treating the entire family if one member does not want to participate
- Inconsistent training and qualifications of family therapists
- Seeing one family member without the others present
- Informing clients of values implicit in the mode of therapy
- Dealing with requests for information from family members
- Sharing values with clients
- Manipulating a family for therapeutic reasons
- Obtaining the informed consent of children
- Preserving the family
60
What are some potential pressures that are observed with group work?
- Verbal abuse (i.e., in member–to–member exchanges) more likely to occur.
- Group leader has limited control in what occurs within the group and outside the group between members (eg. group members going out for coffee).
- Member selection and screening processes may be done poorly, bringing into the group clients who have a limited capacity to work productively in group therapy and/or excluding clients who are not seen as fit for group work.
- Potential for damaging dynamics such as scapegoating, harsh or damaging confrontation, or inappropriate reassurance.
- Group members feeling pressured or coerced to stay or leave group.
- Group members feeling pressured to disclose info with overly confrontational manners and/or failing to intervene when a potentially damaging or humiliating experience occurs.
- Group leaders may be unaware of misuse of power, control, and status in the group.
- Differing expectations from different group members re: physical touch, punctuality, fees, gifts, and leader self-disclosure (boundaries).
- Some group members may be involved in concurrent group and individual therapy, either with different professionals or the same professional/s.
61
What are some things that can be done to assist with confidentiality in group therapy?
Have members complete a group confidentiality agreement in the informed consent procedure.
Document would explain that group co–members have no confidentiality privilege, and describe ways that members can discuss their own progress toward treatment goals without identifying other members.
62
Knauss & Knauss (2012): what are some of the ethical challenges involved in providing multiperson therapy?
```
Billing,
Boundaries,
Collaterals,
Combined individual and group therapy,
Competence,
Confidentiality,
Informed consent,
Domestic abuse,
Ethical issues with high-conflict families.
Record keeping
```
63
What are some techniques in family therapy that require specialized training to use competently?
- Family sculpting,
- communications training,
- paradoxical interventions.
Both family sculpting and paradoxical techniques have been considered manipulative and paradoxical intervention is often regarded as controversial
64
Give an example of paradoxical intervention
If a father disapproves of his son’s friends, the father may be encouraged to insist that the son associate with these friends as frequently as possible
65
What are some concerns with paradoxical intervention
- Deceptive,
- May have unintended consequences, eg. exacerbating negative behavior or causing a family to misunderstand therapist’s intention and terminate treatment prematurely
66
What are some competencies for group therapy?
Developing:
- group cohesion,
- group consensus,
- amount of emotional expressiveness of group members.
How to manage:
- coercion and
- confrontation
67
What are some challenges with informed consent in family therapy?
- Who gives consent?
- Who is the identified patient?
- How capable the participants of understanding the process and potential outcomes?
68
What are two very important issues unique to family therapy that Psychologists should discuss as part of the
informed consent process?
1. whether therapist plans or is willing to see family members individually,
2. whether therapist considers information learned from
one family member when the others are not present
(including information obtained by telephone or
email) to be confidential.
69
What are some issues that are unique to group therapy that should be part of the informed consent process?
- Entrance criteria and procedures,
- Criteria for termination,
- Length & frequency of sessions,
- Fees,
- Goals,
- Methods and procedures of treatment.
- information on the background of the leaders and
their approaches for working in groups
70
What are some of the risks inherent in group therapy?
- Scapegoating,
- Group pressure,
- Breaches of confidentiality,
- Inappropriate reassurance, and
- Hostile confrontation
71
In couple or family therapy what is the most important
| issue regarding confidentiality?
How the therapist will handle “secrets.”
72
What are two divergent positions that psychs may take regarding confidentiality in family therapy?
1. Treat each family member as if individual client -> “info not divulged to other family members”
2. Keep no secrets in therapy from other family members. However, having a no-secrets policy does not mean one cannot have individual sessions; but the therapist is free to reveal info to other family members
73
In terms of clinical practices, is it ok to see members of couple of family individually?
Safest not to see members of a couple or family individually unless they have agreed that the therapist has the discretion of sharing relevant information with other family members.
74
Does family or couples therapy create unique issues with regard to boundaries or multiple relationships?
No - Ethical considerations and decision making about
boundaries and multiple relationships in couples or
family therapy are similar to individual therapy.
75
How does record keeping differ between family and group therapy?
Family = one chart, either all need to sign off on confidentiality or if 1 person seen as 'client' and the others collaterals, then just the client
Group = keep separate records for each group member
