Boundaries in Psychotherapy: Ethical and Clinical Explorations Book

Preface     xi
Acknowledgments     xv
Introduction     3
Boundaries in Context     19
Dual Relationships     21
Rural and Isolated Communities     23
Close-Knit Communities     24
College and University Campuses     25
Professional Training Institutes     27
Mandated Dual Relationships in Military and Prison Settings     29
Financial Dual Relationships     31
Referrals     32
Coauthors' or Collaborators' Dual Relationships     36
Ethics of Dual Relationships     36
Dual Relationships in the Context of Therapy     38
Informed Consent     41
To Dual or Not to Dual: How to Decide About Dual Relationships     42
Reflections on Power, Exploitation, and
Transference in Therapy     47
Power and Boundaries     47
Slippery Slope and Boundaries     51
Transference and Boundaries     54
Contexts of Therapy     59
Client Factors     60
Therapeutic Setting     61
Therapy Factors     63
Therapist Factors     66
A Decision-Making Process for Boundary Crossing and DualRelationships     69
Ethical Decision Making     69
Ethical Decision Making Regarding Boundary Crossings and Dual Relationships     70
Risk-Benefit Analysis of Action and Inaction     72
A Decision-Making Process     75
Boundaries Around the Therapeutic Encounter     81
Time and Money: Managing Time, Fees, Billing, and Bartering     83
Time     83
Fees, Billing, and Other Money Concerns     86
Bartering     90
Case Study: Cursed by Money     97
Space for Therapy     99
Home Visits     100
Outdoor or Adventure Therapy     104
Clinical Interventions Not Possible in the Office     105
Ceremonies, Rituals, and Life Transitions     108
Giving or Getting a Ride     109
Incidental Encounters     109
Contexts of Therapy     111
Confidentiality and Other Considerations in Alternative Therapy Settings     113
Ethics, Standard of Care, Current Procedural Terminology, and Risk Management Considerations     115
Case Study: Hospitality With Strings Attached     116
The Home Office Practice     119
Therapist's Self-Disclosure     121
Managing Time, Places, and People     123
Safety, Privacy, and Confidentiality     126
Client Factors     127
Screening and Informed Consent     128
Ethical Considerations     130
Home Office and Context of Therapy     130
Case Study: A Challenging Setting     131
Telehealth and the Technology for Delivering Care     133
Telehealth and Therapeutic Boundaries     136
Ways That Telehealth Works     138
Clinical, Ethical, and Legal Considerations     139
Guidelines for Using Technology in Psychotherapy     144
Case Study: The Medium Is Not the Message     145
Boundaries Within the Therapeutic Encounter     147
Self-Disclosure     149
Self-Disclosure as an Ethical and Boundary Issue     151
Therapist's Choices in Self-Disclosure     153
The Evolution of Societal and Therapeutic Attitudes Toward Self-Disclosure     154
What the Therapy Setting Discloses     156
Client Considerations     157
Theoretical Orientations     159
Self-Disclosure and Therapeutic Alliance     163
Case Study: Too Much Information     164
Touch in Therapy     167
Touch as an Ethical and Boundary Issue     168
Ethics and Standard of Care Considerations     171
Types of Touch in Therapy     172
Scientific and Cultural Views on Touch     175
Touch in Context     178
Case Study: A Touchy Subject     183
Gifts     187
The Meaning of Clients' Gifts     189
How Setting Affects the Meaning of Gifts     191
Gifts by a Third Party and Medication Samples     193
Timing and Therapeutic Orientation     195
Therapists' Gifts     196
Ethics and Keeping Records of Gift-Giving     197
Therapists' Responses to Clients' Gifts     198
Case Study: A Blessing in Disguise     200
Personal Space, Language, Silence, Clothing, Food, Lending, and Other Boundary Considerations     203
Space Between Therapists and Clients     203
Spoken Language     205
Silence     207
Clothing     207
Sharing Food With Clients     208
Lending and Borrowing     210
Greeting and Sympathy Cards     211
Case Study: From Cupcake to Sculpture-Many Ways to Communicate     212
Final Thoughts     215
Toward a Better Understanding of Boundaries in Therapy     217
Examples of Boundary Crossings and Boundary Violations in Psychotherapy     221
Ethics Codes on Boundaries and Dual Relationships in Psychotherapy and Counseling     227
References     235
Index     255
About the Author     267