Counselor patient relationship

Getting too close to your therapist

counselor patient relationship

Jan 15, Engaging in any type of sexual or intimate relationship with a current client is abuse of power. Clients come into counseling emotionally and. Sexual involvements with former clients and patients, however, are more complicated from Here we see the important relationship between the ethical and the on the client/patient; and (7) any statements or actions made by the therapist. A therapeutic relationship provides a consistent, healing, positive As such, it is very important that therapist provides a safe, open, and.

Beneficence is where the therapist recognizes the importance of doing what is best for the client and benefits the client the most. It is an action that is done to benefit the client. Nonmaleficence refers to the therapist who avoids any activities that may do harm to the client.

counselor patient relationship

This is compared to the Hippocratic Oath of do no harm to the client. Autonomy is when the therapist promotes the client being independent from them. Autonomy helps clients make their own decisions. Justice is when the therapist gives counseling that is equal and fair and does not show favor.

counselor patient relationship

Justice can involve equity, access, participation and harmony. Fidelity is being honest and committed to helping the client make progress. Unhealthy Boundaries One way to avoid unhealthy boundaries as a professional is to ask yourself the following questions when working with a client: How would this be viewed by colleagues, family members of the client, your family and friends?

Is the client being given special treatment that other clients are not receiving? Are you comfortable writing about this in progress notes of the client? Does the action benefit the counselor or the client? Examples of major ethical violations in therapy include self-disclosure when it is given too much from the counselor to the client. Clients do not need to know everything about you in order to have a good therapy session.

Information given should be to help the client in their process of healing, not by giving them additional obstacles to overcome. Other violations include transference, counter-transference, violations of confidentiality, texting or emailing too much, and having a sexual relationship with the client.

Self-disclosure i s when you offer the client information about yourself as a counselor that may or may not benefit the therapy process. The context in which the disclosure is made and the intent behind the disclosure are two very important aspects. Transference refers to the feelings and thoughts a client may have towards a therapist.

Counter-transference refers to the feelings and thoughts a therapist may have towards a client. Clients have a right to confidentiality and should be made to feel confident there information will not be shared with anyone else. There are three situations in which a counselor can break confidentiality legally. One is if the client he or she has threatened harm to self.

Another is if they have threatened harm to someone else. And the third is if the counselor is order by a court to supply information.

If a client feels their boundaries have been violated, they should be made aware of the legal processes they can take. In addition, they can file a report with the Better Business Bureau and the Licensing Board with the state of operation.

This should always be done in the cases of violations to prevent further violations with other clients. If a therapist feels they have gone too far in the relationship with a client, they can seek help from their supervisor or other professionals and refer the client to a different counselor. If there is ever any question about whether or not to do something with a client, wait until you have a clear answer before proceeding.

Ask for help from other professionals, get feedback from superiors in the field, and check the legal ramifications of some behaviors. Clients may feel abandoned if a telephone call is not returned, damaging the therapeutic alliance.

counselor patient relationship

In smaller communities, a counselor may expect to encounter clients in public places. It is wise to discuss in advance with clients the confidentiality and boundary issues that could arise in these situations.

Clients may prefer that the counselor not acknowledge them or may wish to be greeted with a simple hello. Addressing such issues in advance ensures that the client will understand the counselor's behaviors and will not feel ignored or abandoned. Building Trust Building trust has been described as the earliest developmental task and the foundation on which all others are built Erikson, Establishing trust is broadly accepted as fundamental to the development of a therapeutic relationship.

Getting too close to your therapist

However, because adults who were abused or neglected by their parents have experienced betrayal in their most significant relationships, they often find it difficult to trust others. Clients who were not abused by persons close to them also experience problems with trust, but for those who have been betrayed by people on whom they were dependent, issues of confidentiality and privacy are especially critical. Trust makes an individual vulnerable to criticism, abandonment, and rejection.

Clients may therefore be mistrustful and suspicious of the counselor, making the development of a trusting relationship a potentially long and difficult task. Reflecting the transference discussed above, they may fear the counselor or see him as abusive, manipulative, or rejecting. The counselor must not personalize these feelings but be consistent and reassuring, never taking trust for granted Courtois, As clients deal with childhood abuse and neglect issues, they may face a series of crises.

These crises give the counselor opportunities to build trust. In such situations, the counselor can remain consistent and available, helping to allay clients' fear of abandonment and rejection. Many tenets of a good therapeutic relationship unconditional positive regard, a nonjudgmental attitude, and sincerity are also essential for establishing a foundation of trust.

When the Client "Falls in Love" With the Counselor Because of the difficulties many abused clients have with intimacy, the new experience of having someone who listens and whom they can trust can sometimes lead them to believe that they are in love with the counselor.

Sadly, many survivors of abuse are so accustomed to negative feelings shame, fear, guilt, anger that positive feelings joy, trust, contentment, playfulness are unfamiliar to them.

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Such clients may not understand their own feelings, and they may not have the skills to differentiate them. In some cases, if a client has recently stopped abusing drugs or alcohol, romantic obsession or sexual fantasies can substitute for the substance addiction as a way of reducing tension.

Powerful romantic feelings may be directed toward the counselor, threatening the therapeutic relationship. The counselor may first become aware that a client is having strong transference issues by subtle changes in the client's demeanor or by more obvious signs, such as requests to see the counselor in a nonprofessional setting.

The counselor must, above all, avoid transgressing the boundaries of the relationship and continue to emphasize the guidelines discussed when the counselor established the treatment frame. He should not consent to personal requests, even if they seem innocent e. Second, even if he only suspects a client of harboring sexual feelings for him, he should immediately bring the matter to the attention of a colleague.

This consultation will serve not only to protect himself, should legal complications arise later, but can also help him work through the difficulty in the therapeutic relationship itself.

If the counselor senses that a client is developing romantic feelings for her, she can try to discuss the matter openly by asking questions, such as "I sense that you are feeling very strongly about something today. Is there something in particular you want to talk about? Clients should be encouraged to examine the feelings rather than act on them. The tension of this interaction can lead to a "teachable moment" in which the client learns to better differentiate his feelings. The counselor should remind the client repeatedly of the purpose of their sessions, emphasizing what she and the client will and will not do as part of the relationship.

Clients often substitute an attraction to the counselor for an attraction to the abused substance as a way to avoid dealing with unresolved feelings or emptiness. Another, less confrontational way to deal with this type of situation is to maintain the boundaries of the client-counselor relationship but to use clients' feelings to help them discover solid but non-sexual relationships with people who listen. The client can be assisted to differentiate feeling good from feeling sexual desire.

The counselor can explain that the "attractive" aspects of their relationship, such as trust and feeling safe, are qualities that clients will want to look for in their personal relationships. Similar problems of inappropriate attachments and boundary issues can occur in group therapy, and counselors whether as group leaders or in separate individual counseling must be prepared to work with their clients on this dynamic. Here, too, a treatment frame should be established at the outset that addresses interactions between group members and between the group leader and members.

Clients should avoid letting any of these relationships become too personal and should be made to understand why, in this setting, developing sexual relationships would be counterproductive. Counselors, in turn, must understand and support the bonding that occurs when clients make disclosures in a safe and sympathetic environment--and the confusion group members may have about their feelings of dependence on or responsibility for other group members Valentine and Smith, in press. These are therapeutic issues to be addressed in the group that can contribute to the clients' healing from the effects of abuse Briere, ; Courtois, The counselor's reaction to attempts at seduction Because of low self-esteem, incest survivors or other survivors of abuse may feel that the only way they deserve a relationship with another person is if they offer sexual involvement Courtois, If a victim of sexual abuse acts seductively toward the counselor, the counselor should understand that transference issues are in operation and that the victim is trying to sexualize the relationship.

Unfortunately, some counselors do become sexually involved with their clients, thus exploiting the counseling relationship and violating the trust the client has placed in them. Such behavior is unethical, unprofessional, and in some States, illegal.

Counselors who become sexually involved with clients may be reenacting the role of victimizing caretaker. Most treatment programs have policies prohibiting such behavior and will fire staff members who violate these policies.

In addition, they are likely to register a complaint with the State licensing agency; professional associations will censure or expel members who have sexual contact with clients. In some States, sexual contact with clients is illegal, and counselors will be prosecuted. Some in the treatment field believe that males should not treat female survivors of male sexual abuse. Although some women may feel safe only with a female counselor, many male counselors can provide effective treatment if they give adequate attention to abuse issues and their own reactions to clients.

Furthermore, sensitive handling of the case by a male who does not exploit the client can provide a new, positive male role model.

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Whenever possible, the client's preference regarding the counselor's gender should be respected; unfortunately, many facilities do not have adequate staffing to allow choice. In such situations, it is important to openly acknowledge the client's feelings and validate them as understandable reactions. This can reduce feelings of helplessness and help prevent the client from leaving treatment prematurely.

Dealing With Disruptive or Dangerous Behavior Clients in treatment for substance abuse may act rebelliously or violently, a situation that can be exacerbated by an undisclosed history of child abuse. Counselors working with this population have sometimes been victims of physical assault or other violence by clients.

It is the program's responsibility to be aware of and inform counselors of any client's history of violence which may be more common among adolescents in substance abuse treatment.

Counselors should have a personal safety plan, and policies should be in place that require them to call law enforcement and press charges if they are threatened.

As well as taking steps to ensure their own safety, it is the responsibility of counselors to create and maintain a safe environment in which clients can explore and address issues. It is the client's responsibility to behave in ways that do not threaten others either physically or emotionally.

Early in treatment--at the very outset, if it is a group setting--counselors should communicate and enforce ground rules about how clients can safely and appropriately deal with anger and other feelings of discomfort.

Knowing what is expected of them and the other group members contributes toward their experiencing the group as a safe place to share and be heard.

Ground rules should include maintaining members' confidentiality and not sharing any information outside the group, no threats or acts of violence, no verbal abuse, no interrupting other members, and no disruptive behavior. Counselors can help clients learn how to express their feelings constructively by validating their affect but not their expression if it is abusive or violent.

Abuse survivors commonly are concerned about their safety--or their potential reactions to others--while reliving painful events. Counselors can help clients face these feelings by reinforcing the present safety of the counseling environment. In a calm voice, the counselor should ask clients to explore rather than act out anger or disruptive behavior.

counselor patient relationship

The goal is to emphasize to disruptive clients that their feelings are acceptable as long as their behavior remains appropriate. Clients are allowed to have angry feelings--and verbally express them--but they are not allowed to hit anyone, to throw things, or be otherwise violent or disruptive.

In this way, clients can be helped to separate their feelings from their actions.

  • Getting too close to your therapist
  • Necessary Boundaries for a Healthy Counseling Relationship
  • Sexual Issues

The counselor may find that some individuals become caught in obsessive loops, unable to let go of the precipitating issue or to stop being angry. In some cases, this can indicate hidden problems that may need to be explored further i. Constant rage can be a symptom of manic depression or bipolar disorder. Counselors can help create a safe atmosphere for clients and reduce acting out by practicing "grounding" techniques such as the following: Have the client sit in a relaxed posture in a chair with eyes closed or open, if he is uncomfortable closing themfocusing on his breathing.

Ask him to concentrate on feeling the chair supporting his weight and the floor underneath his feet. They may seek justice and restitution in the courts. They may try to prevent the therapist from abusing other patients by filing formal complaints with professional ethics committees, the hospital or clinic if any employing the therapist, and licensing agencies, in part to see if to what degree these organizations are serious about protecting patients from abuse. They may try to make sense of and work through their experience of abuse so that they can move on with their lives.

But on the other hand, they may believe that they need to protect the abusive therapist at all costs. Abusive therapists are often exceptionally adept at creating and nurturing these dynamics. Exploited patients may learn from the therapist that the most important thing is to keep the sexual relationship secret so as not to harm the therapist's career. They may have been led to believe that the sexual relationship was an act of great self-sacrifice on the part of the therapist, a moral and ethical act that was the only way that the therapist could "cure" whatever was wrong with the patient.

Ambivalence of this kind is often found among those who have experienced other forms of abuse. Incest survivors, for example, may experience contradictory impulses to flee the abusive parent, and yet also to cling to and protect that same parent.

Similarly, some battered women will desperately want to escape to safety but also feel an overwhelming impulse to submit to the batterer, to take all blame upon themselves, and to keep the battering secret from all others. Cognitive Dysfunction Many people who have been sexually involved with a therapist, whether the sex started before or after termination, will experience intense forms of cognitive dysfunction.

There may be interference with attention, memory, and concentration. The flow of experience will often been interrupted by unbidden thoughts, intrusive images, flashbacks, memory fragments, or nightmares. These cognitive impairments may interfere significantly with the person's ability to work, to participate in social activities, and sometimes even to carry out the most routine aspects of self-care.

Sometimes the pattern of consequences may fit the model of post-traumatic stress disorder. Emotional Lability Emotional lability reflects the severe disruption of the person's characteristic ways of feeling in a way that is similar to cognitive dysfunction reflecting the severe disruption of the person's characteristic ways of thinking. Intense emotions may erupt suddenly and without seeming cause, as if they were completely unrelated to the current situation.

The emotional disconnect can be profound: Emotions begin to feel alien and threatening, as if they were unwanted intruders into the inner life. Cognitive dysfunction can involve interrupting the flow of experience with unbidden thoughts, intrusive images, etc. The person begins to feel helpless, as if the emotions were completely out of control, as if he or she were at the mercy of a powerful, intrusive enemy, an occupying force.

Emptiness and Isolation People who have been sexually involved with a therapist may experience a subsequent sense of emptiness, as if their sense of self had been hollowed out, permanently taken away from them. The sense of emptiness is often accompanied by a sense of isolation, as if they were no longer members of society, cut off forever from feeling a social bond with other people. She wrote in If I am alone, I will cease to exist. Guilt People who become sexually involved with a therapist may become flooded with persistent, irrational guilt.

The guilt is irrational because it is in all instances the therapist's responsibility to avoid sexually abusing a patient. It is the therapist who has been taught, from the earliest days of training, that engaging in sex with patients is prohibited, no matter what the rationale. It is the therapist whose ethics code clearly classifies sexual involvement with patients as a violation of ethical behavior.

Getting too close to your therapist

It is the therapist who is licensed by the state in recognition of the need to protect patients from unethical, unscrupulous, and harmful practices, and it is the licensing boards and regulations that clearly charge therapists with refraining from this form of behavior that can place patients at risk for pervasive harm.

As the research summarized in subsequent sections will show, gender effects in this area are significant. It is possible that gender may be associated with the ways in which this irrational guilt develops and is sustained. Psychiatrists Melanie Carr and Gail Robinson wrote: The almost universal expression of guilt and shame expressed by women who have been sexually involved with their therapists is a testament to the power of this conditioning" p. Psychiatrist Virginia Davidson, analyzing the similarities between therapist-patient sex and rape, wrote: Women victims in both instances experience considerable guilt, risk loss of love and self-esteem, and often feel that they may have done something to "cause" the seduction.

As with rape victims, women patients can expect to be blamed for the event and will have difficulty finding a sympathetic audience for their complaint. Added to these difficulties is the reality that each woman has consulted a therapist, thereby giving some evidence of psychological disequilibrium prior to the seduction. How the therapist may use this information after the woman decides to discuss the situation with someone else can surely dissuade many women from revealing these experiences.

Impaired Ability to Trust When therapists intentionally and knowingly violate their patients' trust, as they do when they decide to become sexually involved with them, the effects on the patients' ability to trust can be profound and lasting. Therapy may rest on a foundation of exceptional trust. People may walk into the offices of complete strangers and, if the stranger is a therapist, begin talking about thoughts, feelings, and impulses that they would reveal literally to no one else.

Every state, appreciating the exceptionally sensitive nature of the "secrets" that patients may entrust to their therapists, have established in their laws a formal therapist-patient privilege. The ethics codes of all major mental health professions recognize the therapist's responsibility to maintain confidentiality when patients trust the therapist to the extent that they disclose personal information in therapy.