Crossing Boundaries – Clients and Practioners

Situation: Juila, a 24 year old model, comes into see Michael, a Natural Medicine Practitioner for help with her diet, after a few sessions she suggests she and Michael catch up outside of work for a few drinks. Michael begins to feel uncomfortable in the sessions.

THE DEALIO:

As a Natural Medicine Practitioner  a client may feel more comfortable with the practitioner than they may otherwise would be with another medical professional, this is because of a unwarranted stereotype that can be common in people of younger ages as seeing ‘alternative medicine’ Practitioners as ‘Hippies’, a unrealistic expectation in many cases.   This may  result in some cases with the client over comfortable with the practitioner and crosses boundaries.

The main issue in this case study is that the Practitioner is being asked about his personal life, there needs to be clearly defined boundaries from the first session, in some cases it is hard to make these clear without coming off as rude. The balance between crossing the boundaries with relaxed rules and relationships in a professional setting and the ‘emotionally distant forms of therapy’, ( Lazarus & Zur, 2002) mentioned in article 2,  can be hard to achieve. In some cases it is difficult to remain separate from the client in all aspects, as the practitioner needs to open up to the client in order to encourage the client to be forth coming in information. This can cause both good and bad.
Good:

  • You are invested and really want what is best for them, you may even begin to develop a power over them. The ability to convince them that what you are suggesting for them to do is better for them while in a normal setting, they may argue or go against your advice for their health.
  • You can gain a deeper insight into their life, free from limitations of a  patients reluctance of disclosing sensitive information. A wider knowledge of their life and daily interactions can provide insight into their actions and feelings, in another circumstance it would remain hidden from the practitioner, leaving them unaware of what was causing this behaviour of the patient that may not have been explored.

Bad:

  • Objectivity and competence of the practitioner may be impaired when consulting the Patient. The practitioners own opinions may get in the way of their efficiency in deciding what is right for the patients best interests. Instead the  emotional involvement of the practitioner influences their decisions in regards to the patient who may need a more extensive help, for example, where a practitioner may feel it is best for the client due the  emotional involvement of the practitioner for the client to stay in their care, even if it is clear that the client needs further help by a specalist.
  • One may develop a power over the other, and drag the other down and it is a conflict of interest. The patient may come to a power over the practitioner and be able to influence them in an unethical manner, for example the patient may influence the practitioner to break confidentiality made with other patients for their gain.
  • The client may cling to the practitioner for a longer period of time as the ‘friendship’ was bound on something more than the usual. The client may begin to rely on the practitioner for help and instead of being independent, and ‘need’ the practitioner to make simple life decisions for them.
  • The confidentiality clause of the contract between patient and practitioner may be breached, after a dual relationship is created. Dual relationships can be created either by chance or by need. Patients of small communities may only have access to a practitioner whom they have a daily interaction with as a small business owner or a friend of a friend. The problem with these dual relationships is the breakdown of confidentiality between a practitioner and one of their patients, the practitioner may become more relaxed with boundaries and lower standards.
  • There is a risk of exploitive behaviour, either in a sense of confidentiality breakdown or harm. Confidentiality is needed to make the patient feel safe and as if they can discuss their emotions and trust the practitioner, this is essential for a professional relationship in this area to work. The exploitive behaviour can come across as : Mates Rates, Extended session, Forged Treatment Certifications if the patient doesn’t want to or is finding it difficult to complete some mandatory treatment.

An issue for the practitioner it is breaking their personal details, much like confidentiality which protects patients, it is also in place for practitioners. A attraction between patients and practitioner, either one sided or mutual can be unhealthy and defiantly unethical. A patient or practitioner seeking to see the client out of work hours for anything other than what they are trained is unethical and my result in the practitioner no longer being covered.
Transference and counter- transference can occur in a professional relationship between client and practitioner as a shift in emotional feelings from one person to another, described by Freud as

“…new editions or facsimiles of the impulses and phantasies which are aroused and made conscious during the progress of the analysis…”

In other words a “False Connection”, while Transference can sometimes be beneficial for the welfare of the patient, transference can come with many risks such as a transference of negative feelings or dependency. Transference can occur due to a number of reasons, such as the close proximity or a similar characteristic (Hobson & Kapur, 2005). In certain cases it can be beneficial for the boundaries to be crossed in terms of a professional relationship.

A minor boundary crossing such as: Attending a patients mothers funeral, or a patients conformation are good examples where boundary crossing is beneficial.  The patient and practitioner become not only closer as the practitioner lends support but it prevents an altercation caused by the practitioner rejecting the offer. Article 2, Beneficial  Boundary Crossing, page 28. It must be remembered that too rigid a boundary the client may have trouble relating and talking to the practitioner, which helps no one.

 

 

 

 

At the first counselling session after Julia asks to catch up or as soon as he begins to feel uncomfortable, Michael should take a few minutes to clear the air with Julia to ensure that Julia is fully aware that no relationship other than that of a professional one can occur. When Michael reminds Julia that their relationship must maintain ethical, he will need to be aware that she make take it the wrong way, and become offended and embarrassed.

In this situation, Julia is a model, with this there can be an unsurprising link to dietary problems, for example bulimia and anorexia. Perhaps in this case of Julia asking to ‘catch up’ outside of work hours, perhaps is a cry for help, beneficial crossing of boundaries. After all in Article 2 provided, at the bottom of page 28,
Behavioral and family therapy support joining an anorexic or bulimic client for a lunch or for a family dinner.”
While the practitioner would have taken this into account, the state of discomfort while consulting the patient for the practitioner must be handled efficiently. 

AND REMEMBER KIDS, THE NEXT TIME YOU ASK YOUR PRACTITIONER OUT FOR A DRINK AND A BIT OF KINKY TIME YOU ARE CROSSING A LINE Especially if they are a gynocologist or they check your prostate

 

 References:

Hobson, R.P. & Kapur, R. 2005, “Working in the transference: Clinical and research perspectives”, Psychology and Psychotherapy, vol. 78, page. 275-93   http://search.proquest.com.ezproxy.endeavour.edu.au:2048/health/docview/218931969/13BFABBB13F84BBECC/3?accountid=45102

 Article 2:

Zur, O, 2014, “To Cross or Not to Cross: DO Boundaries In Therapy Protect Or Harm”,Psychotherapy Bulletin,issue 39 

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