In the practice of counselling, boundaries in therapy is a term used in the definition of the peculiarity of the therapist-client relationships in comparison to business, sexual, familial, social, and other forms of relationships existing in human interactions (Zur, 2018). For instance, the boundaries drawn in the therapist-client relationships in psychological counselling span a series of issues, including privacy and confidentiality, the fees paid for the services offered, the place, and time of the therapy among others. It suggests that the contact between therapists and their clients is always likely to result in ethical issues defined by the boundaries in therapy. This essay uses the case study of Don and Doctor Martin to highlight a practical case of boundaries in therapy involving privacy and confidentiality and cultural boundaries that existed between Doctor Martin (the therapist) and Don (the client).
An analysis of the case study indicates the existence to two major ethical issues. Specifically, it emerges that Don had been unaware that his therapist suffered from a major psychiatric problem, which caused him to consider if he needed to terminate his contact with her upon discovery of the secret. The second ethical issue in the case study concerns whether Don should discuss his discoveries with his family, especially on his motivations to change his therapist on foundations of cultural differences and mental health status. The Cognitive and Humanistic theories would be useful in explaining factors that promote Don’s behavior and the appropriate course of action that patient and the therapist should take to maximize benefits for each other. The issues in the case study relate to events in daily living in which professionals have been compelled to violate the codes of ethics governing their practice, especially the principles of privacy and confidentiality.
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Case Issues
The case study involves unexpected multiple relationship between Don and Doctor Martin in which the latter was psychotherapist. Specifically, Mr. Don had been sent to investigate insurance claims raised by Doctor Martin. According to the case study, Mr. Don did not expect the client he was supposed to investigate was his personal psychotherapist. Ethical dilemmas arose in the case when Don established that his therapist had been hiding a mental health problem for all the time that they have been interacting. Therefore, as much as he finds that the accident, which had involved Dr. Martin, had resulted in a resurgence of mental health symptoms he felt that he needed to adjust his relationship with her. For instance, he ponders whether to terminate his contact with Dr. Martin for the fear that her mental health problems would risk his life. Secondly, Don wonders if it would be plausible for him to disclose his findings to his family, which appears to have been unaware of his sessions with the psychotherapist.
Both cases present an ethical dilemma. For instance, Don is aware of the ethical standards of his practice as an insurance adjuster, especially that requiring the highest levels of confidentiality in the use of personal information for his benefits. In addition, a concern arises in the scenario in which Don would terminate his contract with the therapist since Dr. Martin might consider it a case of discrimination because of her racial background—she was an African American while Don and his family were White—and he mental health status. From another perspective, dilemma revolves around the quality of therapist-client relationships in the promotion of the wellbeing of both parties involved in the association. For instance, Don needs to act in a way that would preserve the integrity of his therapist while the therapist needs to behave responsibility in her handling of his client, in ways that would promote beneficence and nonmaleficence (APA, 2018).
Theoretical Framework
The cognitive theory would be applied in understanding the ethical issues in the case study. Precisely, the 1960s development by Aaron Beck is a useful way of explaining the manner in which the thoughts and perceptions of individuals would transform their character, behavior, and feelings (Day, 2008). This approach is one of the most useful models of problem solving because it does not focus on the histories of the people concerned in any dilemma. Applying this therapy would always mean that the therapists focus on the present situations of the clients and the manner in which distortions in thought would result in their behavior and feelings. In their application to the case study, one learns that both Mr. Don and the therapist, Dr. Martin, have concerns about their wellbeing. While Don does not want to take chances with his health through consulting a mentally ill person, the doctor is concerned with the type of reception that her client and his family would give her after the discoveries involved in the case study. Therefore, according to the cognitive approach, the lack of trust of each other causes fear and suspicion in the characters of the doctor, Don and her daughter. Furthermore, the conflicting thoughts have the potential of spilling to other parties, especially Don’s employers and family, as well as the board of ethics in the practice of psychotherapy, which provides the ethical framework governing Dr. Martin’s profession.
The humanistic approach is yet another theory that applies to the case study and its related dilemmas. As does the cognitive model, the humanist approach does not dwell on the histories of the people concerned in the course of provision of therapeutic care. The focus of the therapists in this model is always to help the patients realize their greatest potential (Day, 2008). Psychologists who adopt the humanist stance perceive that human actions have intrinsic value of goodness, which is why they would always appear to promote self-actualization and self-growth of the individuals. It is clear that while the cognitive model explains the causes of human behavior in psychological context, the latter one directs the right course of action that the persons concerned in ethical dilemmas should take. In this case, the therapist should be committed to the promotion of the wellbeing of her client. There is only one approach to achieving the objective of the humanist approach, which is the need for the therapist to establish a professional relationship with her client (Day, 2008). Overall, the two theories chosen for the analysis of the dilemmas in the case study suggests that the parties involved should strive to understand the causes of the behaviors depicted by each one of them before seeking approaches that would solve the existing issues and promote their wellbeing.
Related Research
The case study highlights the implications of therapist-patient relationships in the quality of the outcomes of the counselling sessions between them. As do most of the issues in research, contradictions in research on the influence of therapist-patient similarities on the optimizations of the outcomes of their meetings. For instance, one school of thought suggests that therapist-patient similarities reduce the quality of the outcomes while the other perspective is that such similarities improve the outcomes. Whatever the implications of the findings from research, it is imperative noting that the nature of the patient-therapist relationships has significant implications on the counselling outcomes for both of them. This idea, therefore, contributed significantly to the issues in the case study reviewed in this research. However, before detailing the relationship between the study implications, it is critical analyzing the contribution of researchers from the opposing schools of thought.
In supporting the notion that similarities patient-therapist relationships improve the outcomes of their interactions, Grencavage & Norcross (1990) reviewed published literature on the topic in which they ventured into understanding the hypothesis. Their finding suggested that patient-therapist similarities were effective in the promotion of the outcomes of their therapeutic sessions. For instance, the study identified that the more the similarities between the two parties, the better the understanding of the objectives of the sessions convened between them and the stronger the motivation for the patients to attend the counselling sessions (Grencavage & Norcross, 1990). Usually, the objective of the therapists is encourage the patients to attend all the sessions scheduled in the course of their treatment because of the positive contributions of the meetings to their wellbeing. The fact that patients would identify more with the counsellors, the study suggests, makes them to trust the therapists, which stimulates a sense of commitment.
In an opposing standpoint, however, (Mendelsohn & Geller, 1967) notes that incidences of patients missing their counselling schedules with their therapists are common in psychotherapy. The study suggests that one of the reasons that contribute to the demotivation of the patients to attend their meetings with therapists is the fact that they patient-client similarities have significant contributions to the perception of the role of the therapy. Therefore, in the researchers ventured to investigate the contribution of patient-therapist relationships to the quality of the counselling outcomes. They collected data from patients presenting for psychotherapeutic sessions at a hospital in the US and found that significant similarities reduce the motivations of patients to attend counselling sessions because of the perception of a lack of breathing space on their side (Mendelsohn & Geller, 1967).
The contradictions in literature are significant for this research since they point at the role of the quality of patient-therapist relationships in the quality of the outcomes of the sessions. To a significant extent, the researchers point at the need for professionalism between clients and their therapists, which is often the role of the psychologists (Herman, 1998). The most significant issue in the argument is always the need for such sessions to observe the boundaries to therapy and consider the ethical standards of practice (Zur, 2018). In their relationship with the cognitive and humanistic therapies, one learns that professionalism will always direct therapists to concentrate on helping patients handle their immediate issues in ways that would promote their wellbeing. This way, the clients would not feel the pressure of too much or too little attachment to their therapists, which might prompt any of the outcomes proposed in literature.
Action Plan
In solving the ethical dilemmas in the case study, Don should schedule a meeting with her therapist, Doctor Martin that would occur at her office within one week of his visit to her home. During the meetings, the two of them should talk about issues of concern, including their fears about the effects of possible disclosure of personal information from both of them. The therapist should state her commitment to helping her patient handle his immediate fears through showing a strong commitment to ethical standards of confidentiality and privacy, and nonmaleficence and beneficence (APA, 2018). This way, the meeting would be dealing with the negative contributions of thought to the actions of the therapist and her patient, which would promote positive relationships in future.
Conclusion
Therapist-client relationships play a significant role in the quality of counselling outcomes for psychological problems. Studies indicate that therapists should always strive to marinating professionalism in their involvements with the clients. Part of the professional duty of psychotherapists is to avoid instances that would cause them to lose the trust of their patients, which suggests further the need to stick to the code of ethics governing their practice. The fastest approaches to solving issues that would result in relation to patient-client relationships would be to focus on the immediate causes of the emergent issues and the solutions that would be applied to promote the wellbeing of both parties, as the cognitive and humanistic theories direct.
References
American Psychological Association (APA) (2018). Ethical Principles of Psychologists and Code of Conduct . Retrieved 1 June 2018, from http://www.apa.org/ethics/code/
Day, S. (2008). Theory and design in counseling and psychotherapy . Lahaska Press, Houghton Mifflin Company.
Grencavage, L. M., & Norcross, J. C. (1990). Where are the commonalities among the therapeutic common factors?. Professional Psychology: Research and Practice , 21 (5), 372.
Herman, S. M. (1998). The relationship between therapist–client modality similarity and psychotherapy outcome. The Journal of psychotherapy practice and research , 7 (1), 56.
Mendelsohn, G. A., & Geller, M. H. (1967). Similarity, missed sessions, and early termination. Journal of Counseling Psychology , 14 (3), 210.
Zur, O. (2018). Dual Relationships, Multiple Relationships, Boundaries, Boundary Crossings, & Boundary Violations in Psychotherapy, Counseling & Mental Health. Retrieved 1 June 2018, from http://www.zurinstitute.com/dualrelationships.html
