Maintaining the Counselor – Client Relationship

Table of Contents

Abstract

Today, many health professionals use social networking sites, such as Facebook, Twitter, and Instagram. This allows clients to gain access to their counselor’s personal information, make “friendship requests,” and send text messages, which could potentially damage the boundaries of the therapeutic alliance and lead to harmful dual relationships. The purpose of the following paper is to discuss these and other ethical issues presented in the below case scenario and analyze those by following the American Counseling Association’s (ACA) decision-making model. Although ethical codes do not specifically address how counselors are expected to conduct themselves with social networking sites, the analysis of the scenario demonstrated that, when faced with ethical dilemmas, counselors should adhere to the Codes of Ethics. These Codes, along with recent research and the use of current decision-making models can help the counselors determine the best course of action; help maintain and grow the counseling relationship; prepare the counselors to face future ethical dilemmas; and promote the discovery of new tools in the digital world, which could prove useful in their future practice. Keywordscounseling, a dual relationship, ethics, dilemma, social media.

Maintaining the Counselor-Client Relationship

For the purpose of this paper, case scenario was chosen of John employed as the counseling intern for an outpatient facility specializing in alcohol and drug addiction recovery. Professional counselors engage in practice with an understanding that, if faced with an ethical dilemma, they will take necessary steps to formulate and implement the most ethically appropriate decision. Unfortunately, this is often easier said than done, as most counselors must also uphold client expectations and agreements and abide by employer regulations; all while continuing to maintain the counselor-client relationship. To complicate the matter, the advent of social networking sites, such as Facebook, potentially allows clients nowadays to gain access to their counselor’s personal information, make “friendship requests,” and send text messages, which could potentially damage the boundaries of the therapeutic alliance and lead to harmful dual relationships (Yonan, Bardick, & Willment, 2014). The following paper will discuss these and other ethical issues presented in the above case scenario and analyze those in the following discussion following the American Counseling Association’s (ACA) decision-making model as outlined in A Practitioner’s Guide to Ethical Decision Making by Forester-Miller and Davis (1996).

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Identifying the Problem

Confronting Self-Disclosure Issues

       Today, many health professionals use social networking sites, potentially allowing the clients to gain the information necessary to contact them on a personal basis. This involves the issue of privacy and the problem of clients “requesting their counselors’ friendship,” which puts counselors in a position where they need to accept, ignore, or reject the request, thus potentially affecting the therapeutic relationship (Yonan et al., 2014). In the aforementioned scenario, the fact that John accepted a “friendship request” from Ben initiated a dual relationship; on the other hand, his decision to decline Jeanne’s request could have potentially damaged a working alliance. Although ethical codes do not specifically address how counselors are expected to conduct themselves with social networking sites, there is a breach of ethics in the above-described situation. Thus, counselors should engage in an ethical decision-making process when such situations arise.

Balancing Dual Relationships

       Establishing proper boundaries in a counselor-client relationship is imperative for at least two reasons. First, counselors have an ethical and legal responsibility to do no harm to their clients. Second, not only violated boundaries harm the clients, but they can also potentially damage the reputation of the discipline of professional counseling. In addition, the advances in technology are placing new pressure on the counselor-client relationship, paving the way for harmful dual relationships (Yonan et al., 2014). In the above case scenario, the fact that John accepted Ben’s “friendship request” not only violated the boundaries of the therapeutic relationship, but also engaged him in a dual relationship with his client. Another possible dual relationship that contributes to John’s ethical dilemma is Jeanne’s “friendship request.” Though John declined the request, Jeanne was asking to extend the existing counseling relationship past the professional arena into a more personal realm. Thus, it is very important that counselors consider the impact of recent technology on the boundaries of the therapeutic relationship, because the fact that John neglected to protect those boundaries adds to the problem not only ethical, but also professional dimension.

Applying the ACA, NAADAC, and State Board’s Codes of Ethics

Both the ACA (Section A) and NAADAC’s Codes of Ethics (Principle I), as well as Rules and Regulations of the State of Georgia (Rule 135-7-.01), consider client’s welfare to be of the utmost importance. According to all three Codes, counselors can never act in a way that may intentionally harm the client and must avoid negligently harming the client’s interests as well (ACA, 2014; NAADAC, 2016; Rules and Regulations of the State of Georgia, 2019). Based on these standards, it would have been in the best interest of Ben if John had not accepted his “friendship request.” However, since John did accept it, it should be John’s duty to try to rectify this issue, bringing as little harm as possible to his client. As regards boundaries and dual relationships, both the ACA (Section A) and NAADAC’s (Principle I) Codes of Ethics advise counselors against engaging in unprofessional relationships with their clients (ACA, 2014; NAADAC, 2016). This issue is further explained in the Section H of the ACA code and the Principle VI of that of NAADAC’s, specifically stating that counselors are to abstain from entering into a personal virtual relationship with current clients and requiring counselors to maintain a professional site that is separate from their personal profiles (ACA, 2014; NAADAC, 2016). Furthermore, both the ACA (Section H) and NAADAC’s (Principle VI) Codes oblige counselors to inform clients of the counselor’s use of social media services and to explain the benefits, limitations, and boundaries of the use of social media as part of the informed consent process (ACA, 2014; NAADAC, 2016). Unfortunately, the Code of Ethics of the State of Georgia (Rule 135-7-.02) does not address the social media dilemma, but supports both the ACA and NAADAC’s Codes by charging the counselors to be aware of any action that might interfere with the effectiveness of treatment or potentially lead to harm, whether it be to the client or to the counselor (Rules and Regulations of the State of Georgia, 2019).

Seven tips for maintaining the counselor – client relationship

Show trust to your customer by showing understanding, good listening skills and true worry for their happiness or health. By making a safe and fair place for customers, they can talk more easily.

Help clients feel comfortable sharing their thoughts and emotions by promoting good talking. Make sure your own messages are simple and focused, always ensuring that customers understand what you’re telling them.

Keep the relationship between counselors and clients healthy by setting clear professional limits. Make clear the boundaries of helping relationship and follow good conduct principles. Being professional helps you get respect and trust too.

Be nice and aware of the different cultures in your clients. Recognize and tolerate different cultures, this helps create a more welcoming place where people feel understood.

Help clients make decisions by including them. Work together with the client on their treatment goals and give praise for what they can do well. This shared way helps make people feel they are part of it and believe in their ability to do well.

Check in with your clients regularly about the help they’re getting. Support them to give their thoughts on what they’re going through, and be ready for changes based on what matters to them. This keeps a customer-focused way to work.

Keep up-to-date on the newest news in talking with counselors and therapists. Keep learning new things to improve your skills and knowhow in your job. This focus on growing helps you and your customers.

Determining the Nature and Dimensions of the Dilemma

When determining the appropriate steps to take when confronting ethical dilemmas, a counselor should take into account moral principles, relevant literature, and the suggestions of colleagues and professional organizations. According to Forester-Miller and Davis (1996), there are five moral principles that form the basis of counseling ethical standards: autonomy, nonmaleficence, beneficence, justice, and fidelity. These ethical principles can help bring clarity to an issued-filled situation. However, when applied to certain situations, it is the responsibility of the counselor to prioritize them in order to resolve an ethical dilemma (Forester-Miller & Davis, 1996). Applying these principles, along with the suggestions of recent research and supervisors, will lead John to make the most effective ethical decision.

Considering Moral Principles

       When considering the above case scenario, it is clear that becoming a Facebook friend with John could challenge Ben’s autonomy, since it would open the door to dependence on the counselor. As regards nonmaleficence and beneficence, John could have avoided engaging in a dual relationship with Ben and potentially damaging the working alliance with Jeanne by abiding with the standards outlined in the ACA and NAADAC’s Codes of Ethics that prohibit befriending clients on social media and warn against engaging in an action that could harm the clients. As far as justice is concerned, Forester-Miller and Davis (1996) explain that counselors should “treat equals equally and unequals unequally but in proportion to their relevant differences.” This means that counselors must offer an explanation clarifying the appropriateness and necessity of their decision if a client is to be treated differently (Forester-Miller & Davis, 1996). In John’s situation, no explanation was given to Jeanne that would fit either requirement of justice concerning his decision to decline her “friendship request.” Finally, to promote fidelity to the clients, it would be better for John to remain the counselor only, instead of bringing another role into the relationship. Because if John were to become Ben’s sponsor, John would be making a promise to Ben to be present and available outside of his expected counseling commitments.

Reviewing Relevant Literature

       Both the ACA and NAADAC’s Codes of Ethics strictly prohibit virtual relationships with current clients. However, there has been found conflicting research regarding this issue. Since creating appropriate boundaries is important to the therapeutic relationship, Remley and Herlihy (2016), as well as Yonan et al. (2014), suggest that in order for counselors to maintain the counselor-client relationship, they must adhere to the ACA Code of Ethics. Arguing that therapeutic boundaries may be crossed or violated when clients and counselors attempt to befriend each other, the researchers, however, acknowledge that the use of recent technology may have its benefits (e.g. potentially improve service delivery) (Remley & Herlihy, 2016; Yonan et al., 2014). On the other hand, Zur and Walker (2015) argue that there has not been found any substantial evidence whether engaging in social networking with clients is detrimental to the client. However, the researchers encourage the counselor to approach a situation of befriending a client on social media with caution and to take into account if such “friendship” could affect the treatment of the client and the counselor-client relationship (Zur & Walker, 2015).

Consulting Professional Colleagues and Organizations

       In any counseling situation, it is important to engage in official supervisory discussions or collegial consultation (Yonan et al., 2014). In John’s ethical dilemma, it is essential to contact any available source of consultation he may have, taking into account the confidentiality of his clients and the situation. John should also consider whether the addiction program he is engaged in offers an ethical code of some sort, which may preclude him from engaging in the sponsoring relationship with Ben and Jeanne in the future. Any additional comments about his future actions should also be fully considered.

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    Generating Potential Courses of Action

    Before receiving any social media “friendship request,” counselors are advised to address this issue as part of the informed consent process. However, since the scenario included John accepting Ben’s request, then one potential course of action would be for John to limit the information that Ben can see through filtering. Another potential course of action would involve John informing Ben of his mistake and recanting his acceptance. However, there is a third potential course of action that would require of John to delete his personal social media account and create a professional page adhering to the ACA and NAADAC’s Codes of Ethics, providing that the facility John is working for would allow this.

    Considering Potential Consequences

           By accepting Ben’s “friendship request,” John can validate the client’s needs to connect personally and promote a more positive interaction outside of the therapeutic relationship. However, John would have to constantly monitor what he posts on Facebook since Facebook’s Privacy Policy states that one creates an account with the understanding that “information might be copied or shared with others” (as cited in Yonan et al., 2014). Since John befriended Ben, he would have to ensure that his multiple roles – counselor, friend, and potentially future sponsor – would not compromise confidentiality or interfere with Ben’s treatment plan or overall well-being. On the other hand, if John recanted his acceptance of Ben’s request or deleted his social media account, he would have to discuss an appropriate counselor-client relationship in order to prevent Ben’s feelings of abandonment and validate Ben’s, as well as Jeanne’s wishes, to connect on a more personal and therapeutic level.

    Determining a Course of Action

           Once John has explored all of his options and discussed potential consequences and benefits with his clients and with other professionals, he will be able to come to the most appropriate and ethically correct decision. Since a dual relationship with Ben has been formed, John should recant his acceptance of Ben’s “friendship request,” and more importantly, discuss his choices and the ramifications for the decision with both Ben and Jeanne. Furthermore, if John were to delete his personal account and create a professional social media page with the approval of the facility, he could befriend both Ben and Jeanne and his future clients, and hopefully rectify the damage he has done through the provision of another option and continuation of the counseling relationship with little to no damage. Finally, John would have to seek outside supervision throughout his entire internship in order to gain support for his decisions and any future opposition he may find because of them.

    Evaluating the Selected Course of Action

    Upon the decision to recant his acceptance of Ben’s “friendship request,” while engaging in appropriate counseling, John should run this option through three tests developed by Stradler: justice, publicity, and universality (as cited in Forester-Miller & Davis, 1996). First, John must determine whether he would treat other clients in the same manner. Secondly, if John were to face public reporters, most Codes of Ethics agree that he would be able to appropriately represent the counseling profession, while maintaining his own personal values and beliefs. Finally, because the suggestions made to John have been based on a current decision-making model and research, it would be highly recommended that the same results should be applied to a counselor in the same situation.

    Keep secrets to make people trust and encourage them to share their thoughts without fear. This is important for clients who need privacy while talking about what they are thinking or feeling. Counselors need to follow rules of right and wrong. This guards their client’s private details, but only when there is danger involved should they break this rule.

    If you feel someone is crossing the line, talk about it quickly and firmly. Talk to the client about why it’s important for them and their well-being that professionals keep worklines clear. Talk to your boss or ask for help from coworkers if needed.

    Work together with the person you’re helping to check and change their treatment goals. Look at any problems that could stop improvement and change the way of helping if necessary. It’s very important to always talk clearly and often check if the tactics being used are working well.

    Understanding and respecting different backgrounds is very important when working with clients. This skill, called cultural competence, helps a lot. Understanding different cultures and changing your ways helps make a place welcoming. This makes counseling more effective by making it usable to everyone, including people of all backgrounds.

    It’s hard but very important to mix feeling for others with clear thinking. Empathy helps you feel connected with clients on an emotional level. But, being professional keeps your decisions and thoughts clear based on what the client really needs or wants to achieve. Regular checking and thinking about ourselves can help us have balance.

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    Implementing the Course of Action

      In the present case, it is important for John to speak with both Ben and Jeanne to ensure they understand his choices and the ramifications for his decision. This will provide John with the information he needs to continue to be an effective counselor and validate Ben and Jeanne’s wishes to connect on a more therapeutic and personal level. Becoming confident in a chosen plan and familiarizing Ben and Jeanne with its strengths and limitations can provide comfort over the decision John has made. Prepping the counselor’s professional social media page can also add a sense of professionalism and place John in the correct mindset to provide therapy. In addition, by keeping communication open with his clients, John can insure accountability by checking on the quality of the new form of therapy and ensure that it is meeting the client’s needs and expectations.

    Conclusion

    When faced with ethical dilemmas, counselors should reference Codes of Ethics for guidance. These Codes, along with recent research and the use of current decision-making models can help determine the best course of action. As regards John’s case, his decision will affect not only his relationship with Ben and Jeanne, but also with future clients and his view of the profession as a whole. Because John is a counseling intern, he is not forced to face decisions alone and can rely not only on his own, but also on his supervisors’ decision-making skills in the present and future ethical dilemmas. Also, John will most likely be faced with technological dilemmas in the future; therefore, being aware of his social networking site privacy and all that that entails is of utmost importance when preventing similar ethical dilemmas from happening again. To conclude, one may hope that John’s decision will serve the best interests of both Ben and Jeanne; help maintain and grow the counseling relationship; prepare John for facing future ethical dilemmas; and promote his discovery of new tools in the digital world, which could prove useful in his future practice.

    References

    CA, American Counseling Association. (2014). ACA Code of Ethics. Alexandria, VA: ACA. Retrieved from https://www.counseling.org/resources/aca-code-of-ethics.pdf Forester-Miller, H., & Davis, T. (1996). A Practitioner’s Guide to Ethical Decision Making. American Counseling Association. NAADAC, the Association for Addiction Professionals. (2016). NAADAC/NCC AP Code of Ethics. Alexandria, VA: NAADAC. Retrieved from https://www.naadac.org/assets/2416/naadac-code-of-ethics.pdf Remley, T.P., & Herlihy, B.P. (2016). Ethical, Legal, and Professional Issues in Counseling. New York, NY: Pearson Education, Inc. Rules and Regulations of the State of Georgia. (2019). Code of Ethics. Retrieved from http://rules.sos.ga.gov/gac/135-7?urlRedirected=yes&data=admin&lookingfor=135-7 Yonan, J., Bardick, A.D., & Willment, J.A.H. (2014). Ethical Decision Making, Therapeutic Boundaries, and Communicating Using Online Technology and Cellular Phones. Canadian Journal of Counseling and Psychotherapy, 45(4), 307-326. Zur, O., & Walker, A. (2015). To Accept or not to Accept? How to Respond when Clients Send “Friend Request” to Their Psychotherapists or Counselors on Social Networking Sites. Retrieved from http://www.zurinstitute.com/socialnetworking.html

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