Ethics Update – By Perry C. Francis

Boundaries and the little things that matter

keep a small refrigerator in my Given the circumstances, we quickly something that had already been clinic office to store my lunch and worked through a generic ethical apparent for decades: Our relationships I several bottles of iced tea. I enjoy decision-making process and decided with our clients are multifaceted and the tea during the day as an alternative it was best for him to offer his heartfelt complex. With this revised concept of to water, just to have something thanks but to tell the clients he could not dual relationships, we could no longer different. One of my clients, noticing accept their gift. Try as he might at the hide behind the idea that a therapeutic my stash of iced tea bottles that had not next session, however, the couple refused relationship was somehow not personal yet made their way into the refrigerator to take the gift card back. They insisted for both the client and the counselor. and also knowing that it was very hot that the counselor-in-training keep it or Instead, we had to learn how to manage outside, asked if she could have a bottle donate it to the training clinic, saying those relationships for the benefit of “for the road.” they had recovered enough financially the client. I get this tea in bulk at Costco, so it to be able to afford such a gift. Besides, The 2014 ACA Code of Ethics refined costs me only about 75 cents per bottle. the couple noted, they were paying next standards around managing and If I give this client a bottle of tea, am to nothing for the sessions (we operate maintaining boundaries and professional I violating some therapeutic boundary on a sliding fee scale) and wanted to say relationships to add clarity (see Standard and leaving the impression that our thanks. The counselor-in-training thus A.6.). The standard related to receiving relationship is something more than accepted the card as a gift for the clinic, gifts from clients first appeared in the professional, or am I just being humane and we were able to use it for the benefit 2005 code and remained relatively to someone who is thirsty and heading of other clients. unchanged in the 2014 revision out into a hot day? Do I need to place a (Standard A.10.f.). Before that time, note in the case file indicating that I gave Minor concerns, common wisdom prevailed that it my client a bottle of cold tea to ensure major consequences? was inappropriate to accept gifts of that I properly document this boundary A common theme in both of these substantial value from our clients. This extension, or can I just consider it a cases revolves around how a counselor wisdom remains intact today. simple act of kindness to a client? Is there responds to a client request or action a simple answer to this question? when that request or action can be Boundaries of the professional Sometime back, one of our counselors- perceived either as innocuous or and personal relationship in-training came to me with a concerned as being on the edge of violating a So, how does one maintain the look on his face. It seems a couple he relationship boundary. Although filling professional relationship while had been working with gave him a $50 a client’s request for a bottle of tea or acknowledging that counseling is a gift card as a token of appreciation for accepting a small gift from a client personal endeavor? Let’s start at the helping them through some tough times. would seem to be minor concerns, our beginning with the informed consent He was aware that money was tight actions as counselors can have powerful process. As the ethics code was developed for the couple and knew that $50 was consequences that either enhance or and revised, we listed the many types of probably a stretch for them. Additionally, damage the therapeutic relationship. information that need to be explained the counselor-in-training was aware of This all became more complex with and examined with clients prior to the 2014 ACA Code of Ethics standard the publication of the 2005 ACA Code of discussing the issues at hand (see that addresses receiving gifts (Standard Ethics, which revised the concept of dual Standard A.2.b.). A.10.f.) and wanted to check in with relationships (having both a therapeutic Nowhere on that list of things to me as the clinic director to determine and nontherapeutic relationship with a discuss is there mention of gift giving or what to do. client). The 2005 ethics code recognized other related matters. In fact, it might

12 | ct.counseling.org | August 2019 seem presumptuous on the part of a any decision-making process when the professional counselor to assess the counselor to say, “No gifts are necessary determining the counselor’s response. context of the situation and to determine at the termination of our time together.” But what is a counselor to do when, an appropriate course of action. After all, this might be perceived as as in the second example above, the implying, “I am so good that you will counselor and the client share the same Conclusion feel the need to offer me something more culture and the gift simply represents With certain exceptions, we no than my customary fee.” an expression of thanks? Once again, longer live in a world in which we What is being addressed in both broad the need arises to discuss the meaning maintain rigid boundaries as professional and specific strokes is the boundaries of and significance of the gift for the counselors for fear of contaminating this professional and personal relationship. client and to examine the nature of the the therapeutic relationship. We can In others words, “This is what you can counseling relationship. Additionally, extend boundaries when appropriate expect from me, and this is what I expect and more concretely, the value of the gift (e.g., attending a client’s wedding or from you.” It is important to share with must be considered. Is it a small token commitment ceremony) with the the client that counseling has a uniquely of appreciation (e.g., a houseplant or proper precautions and after discussing personal dimension, especially for the a novelty coffee cup) or a gift of some it with the client. These extensions client, and that the counselor is present value (e.g., a $100 gift card to a local may, in fact, enhance the therapeutic as the professional in this process. It is restaurant)? A general rule to follow is relationship, build closer rapport and important to offer this information in a to return anything with an approximate lead to greater healing. culturally sensitive way (Standard A.2.c.) value of more than $25 with humble Or, when necessary, we can choose to and to assess the client’s expectation not thanks and an explanation about the maintain a boundary with a client. When just through the lens of the counselor’s nature of a professional counseling this happens, it requires a discussion that culture or that of the majority of the relationship. Counselors should manage helps the client understand the necessity people in the community, but from the their actions on a case-by-case basis and of the boundary and how it protects the client’s worldview and cultural norms. document their actions, in a case note, therapeutic relationship. regardless of the decision reached. Regardless of the action taken, The decision-making process How about if the counselor gives documentation of the discussion and The vast majority of ethical dilemmas something to a client, such as in the first decision must be made in the case file. can be solved by working through a case example? May I offer my client a Although the process has become more complicated, in the end it benefits both robust ethical decision-making process. cold tea, especially on a hot day? Would the counselor and the client. v Managing boundaries and navigating the it be appropriate to offer clients a token challenges of clients offering their thanks of our work together that symbolizes in ways that make you uncomfortable are their progress or reminds them of how no exception. far they have come in therapy? It is important to first consider the The spirit of our ethics code reminds motivation of the client. One place us that our primary responsibility is to to begin examining that motivation is promote the welfare of clients (Standard with the culture of the client. One of A.1.a.). So, two question that must be the values of the counseling profession, asked are: Perry C. Francis is a professor of as delineated in the 2014 ACA Code of 1) How will my actions be perceived counseling at Eastern Michigan Ethics preamble, is “honoring diversity by the client? University and coordinator of and embracing a multicultural approach 2) How will my actions impact the the counseling training clinic in in support of the worth, dignity, professional relationship with the client? the College of Education Clinical potential and uniqueness of people If the client perceives my actions as Suite, where he sees clients and within their social and cultural contexts.” something other than professional or supervisees. He chaired the ACA This is lived out in many different ways an act of simple human kindness that Ethics Revision Task Force that in the counseling relationship. might be offered to anyone, it can developed the 2014 ACA Code of For example, some cultures perceive create a mistaken impression about Ethics. Contact him at pfrancis@ offering a small token or gift as an the relationship. This, in turn, affects emich.edu. acknowledgment of respect. Processing how the client views the counselor and with the client the meaning of the gift can create confusion on the part of the Letters to the editor: can be quite impactful for the counselor client about the counselor’s intent. This [email protected] and consequential for the client. This is especially true with clients whose doesn’t need to be a drawn-out affair issues may center around overly rigid or but rather a simple discussion. What diffuse boundaries. On the other hand, might appear to be a simple token a client with healthy boundaries might from a client can, in fact, have a consider the counselor’s action a simple significance far beyond the value of kindness that communicates respect, the gift. This must be weighed in care and decency. It becomes your job as

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