Maintaining appropriate boundaries
One of the core concepts of ethical counseling involves the complex area of maintaining appropriate professional boundaries. Most counselors know that there are ethical risks to developing relationships outside of the therapeutic role, such as counseling a friend or pursuing business or social interactions with clients. These types of dual relationships can impair a counselor’s objectivity or unintentionally exploit a client’s dependence (Pope and Vasquez, 1998). Yet some subtle boundary issues present ethical dilemmas that are neither obvious nor easily avoidable.
In order to maintain appropriate clarity of roles, a counselor should only reveal intimate personal information when doing so is clearly relevant to the client’s treatment goals, carefully tailoring this information to the client and paying close attention to how such sharing affects the clinical relationship (Bloomgarden, 2000). Consultation with colleagues and supervisors can help insure that the true purpose for disclosing personal information is to meet the emotional needs of the client rather than the counselor. One helpful guideline is for a counselor to reveal information about a personal life problem only well after it has been resolved, and not while it is an ongoing issue (Hunter and Struve, 1998).
Since a significant proportion of clients with addictive disorders have a history of childhood trauma (Briere, 1992), even a simple act of touch can convey a variety of ethically ambiguous messages. The history of addiction support is replete with reassuring hugs. It’s very important for a counselor who engages in any form of physical contact with clients to have a highly developed sense of boundaries and an astute awareness of the clinical implications of this behavior. The initial stages of the therapeutic relationship may not provide sufficient emotional safety to ensure that a client can discuss any uncomfortable feelings involving the counselor’s touch (Hunter and Struve, 1998).
Sexual involvement with a client constitutes a profound ethical violation with severe emotional consequences. However, occasional sexual feelings are not in themselves either unethical or even particularly abnormal in the context of an intimate therapeutic relationship (Pope and Vasquez, 1998). Counselors must acknowledge and appropriately process the existence of these feelings when they emerge in order to successfully understand and redirect them. The presence of intense preoccupation or sexual fantasies involving clients needs to be forthrightly discussed in consultation and supervision.
Counselors who have successfully dealt with addictive disorders in their own lives can often relate to their clients with profound understanding, empathy, and clarity. However, they may also be overly devoted to the treatment approach they personally found successful (Johnson, 2000). For instance, counselors who are strongly 12-step oriented may discount non-abstinence models for addressing substance abuse, such as risk reduction strategies, which threatens to place clients into a one-size-fits-all philosophy of care.
A counselor who is candid about being “in recovery” may give clients hope and reduce the shame that inevitably accompanies addiction. However, too much disclosure can be intrusive and distracting for some clients, and can even inadvertently generate unrealistic expectations or a sense of inadequacy (Bloomgarden, 2000). Counselors should therefore carefully reveal information about their personal addiction experience only in as much detail as is necessary to meet a compelling and clearly defined clinical need.
A counselor who is treating clients with substance use disorders should not be unsuccessfully fighting the same battle. Sustained abstinence from addictive behavior is an inescapable ethical responsibility for anybody working in this field. Counselors with less than several years of recovery time may easily lose objectivity when dealing with clients whose clinical picture mirrors their own personal experience. Heightened levels of consultation and supervision are highly advisable in such circumstances.
Nobody is immune to relapse, regardless of the length of time in recovery. A counselor who reverts to a previous pattern of addictive behavior must face the ethical dilemma of whether to limit, suspend, or terminate clinical duties. Abruptly withdrawing services from a client due to this (or any other) form of counselor impairment is likely to be deeply disruptive to the client’s healing process (Bissell and Royce, 1994). Clients in such situations must be given the opportunity to continue counseling with another provider. There is no one answer to the problem of counselor relapse that is completely satisfying. In this regard the difference between a temporary “slip” that can result in increased self-awareness and an unrestrained relapse may be useful in determining a counselor’s overall level of clinical impairment. These decisions should be made in a process of supervision and consultation so that the counselor is not relying on his or her personal judgment, which may be impaired.
All counselors who are in recovery from addictive behavior must establish whatever safeguards are necessary to ensure the maintenance of a personal program of sobriety. This may include establishing boundaries around support group meetings that clients are asked not to attend. It is not ethically appropriate for counselors in 12-step recovery to sponsor their own patients or chair meetings where they are employed (Bissell and Royce, 1994).
Taken from Basic Core Ethical Guidelines For Addiction Treatment Professionals