Psychology Case Study

CASE STUDY

What are the issues around maintaining professional boundaries and dual relationships for natural medicine practitioners?

PART 1

1. Identify and assess the key issues for the practitioner raised by the case study.

* The client (Julia) is seeking personal information from her practitioner (Michael) and suggesting meeting outside of appointment hours, therefore challenging his personal and professional boundaries. Practitioners are repeatedly warned about involving themselves in dual relationships as they are seen as 'unethical and often used synonymously with exploitation and harm' (Zur, 2004)

* Michael needs to evaluate his personal behaviour towards Julia. He needs to identify if he has intentionally or unintentionally stepped outside his role as a primary healthcare physician and crossed his own professional boundaries on patient relationships. Eg. Enquiring about Julia's social life, which has no relevance in Julia's treatment plan. She may misinterpret this as a special interest in her.

* Michael needs to ensure that he has established clear, professional boundaries with Julia and that she understands what that relationship entails. Golden (1995) states that 'It is important for clinicians to set limits on their professional relationships before a crisis develops.'

* Michael must assess if these incidents have nullified the client/practitioner relationship. Will Michael still be able to promote what is good for his client or does Julia need to be referred to another practitioner?

2. Compare and contrast the views of the articles in relation to the issues raised by the case study.

Briefly discuss these views using appropriate referencing.

It is important to define the following terms in order to understand the complexities of professional boundaries and dual relationships: (Zur, 2004)

Dual Relationships- where two or more connections exist between a client and a therapist. These are very common in small, rural communities.

Boundary Violation- When a therapist engages in unethical practice and misuses his/her power to exploit a client for the therapist's own benefit. These violations are illegal in psychotherapy practices.

Boundary Crossing- refers to any form of therapy that strays from traditional analytic and risk management practices, i.e., office based therapy that follows strict time and practice protocols.

It must be said that the three articles discussed in this case study refer to the psychotherapy and counseling fields. While this still falls under the banner of health care practitioners, the scope of practice of a psychotherapist differs considerably to that of a natural health practitioner.

All three articles agree on the premise that a sexual relationship with a patient is a boundary violation and completely unethical. What is not so clear is the 'grey area' that exists surrounding boundary crossing and dual relationships.

In relation to the case study, it is understandable that Michael would be uncomfortable by Julia's increased interest in his personal life. One assumes he would understand the 'slippery slope' (Zur, 2004) that is beginning, could lead to serious boundary violations.

However, in regards to nonsexual boundary crossing and dual relationships there are differing opinions.

Some health professionals argue that all nonsexual dual relationships and boundary crossings only lead to harm and must be unconditionally avoided, while others maintain that these relationships are not only at times unavoidable but, can foster a more trusting therapeutic relationship between patient and practitioner. (Nickel, 2004)

To set rigid guidelines stating that all dual relationships and boundary crossings are a violation is seen by many practitioners as being too simplistic, and fails to offer advice on ethical-decision making. (Nickel, 2004)

There are many counseling interventions that fall under the heading of boundary crossing, eg. Conducting a session in an outdoor environment, and all articles conclude that boundary crossing should be conducted based on the individual cases and circumstances in which therapy occurs. If a practitioner chooses to be flexible with their professional boundaries they should do so with careful consideration of the outcomes and ensure that they are motivated only by what is best for the patient.

However, the practitioner in the case study is not a psychotherapist