The presented case is related to the boundary crossing problem in practitioner-patient relationships. Ms. Rosalind, a client who recently experienced a traumatizing divorce, asked for mental health help in a local outpatient clinic. Ms. Cheney, the therapist, who had also lived through a divorce in the past, found herself identifying with her client’s comments. Soon Ms. Cheney befriended Ms. Rosalind as both women realized they shared many common interests. At first, the practitioner and her client began meeting for coffee after the therapy sessions. Ms. Rosalind enjoyed Ms. Cheney’s company and suggested spending more time together. Ms. Cheney agreed and became a close friend to her client. They started to spend a significant amount of time together, visiting clubs, movie theaters, and local restaurants on evenings and weekends.
However, their friendship ended abruptly as Ms. Rosalind and Ms. Cheney fell in love with one man. The practitioner and the client had an argument, which resulted in Ms. Rosalind filing a formal complaint with the regulatory agency. Ms. Rosalind remained Ms. Cheney’s client throughout the practice course, so she felt betrayed and exploited by her therapist. The information presented in the case implies that Ms. Cheney had good intentions but could not avoid the slippery slope phenomenon when the positive impact of boundary erosion turns into harm (Corey et al., 2019). Regardless, the dual relationships where Ms. Cheney became more than a healthcare services provider had negative implications for both parties. Ms. Rosalind’s trauma has worsened, whereas Ms. Cheney may be subjected to severe disciplinary measures, depending on the regulatory agency’s decision.
Harmful Effects
The situation described in the case harms all parties: Ms. Rosalind, Ms. Cheney, and the helping practitioner-client relationship. On the one hand, Ms. Rosalind faced severe confusion, disillusionment, and disappointment, a likely outcome of the professional boundary violation (Reamer, 2012). Ms. Rosalind befriended Ms. Cheney and trusted her, only to find that her therapist had the same love interest. Ms. Rosalind had likely believed that she had met a good friend in Ms. Cheney and found love again. Instead, she found that Ms. Cheney is not a friend but a rival in romantic relationships.
On the other hand, Ms. Cheney also faced harmful personal and professional effects of poorly executed boundary crossing. In terms of personal consequences, she has lost a friend, which is damaging on its own. However, Ms. Cheney has also damaged her professional record, even if the regulatory agency does not find her guilty of unethical conduct. Most importantly, her approach to multiple relationships has caused harm to the client. While codes of ethical conduct do not prohibit nonsexual practitioner-client relationships, a practitioner should seek professional advice before agreeing to them (Corey et al., 2019). Given the information presented in the case, the negative outcome stemmed from Ms. Cheney’s hastiness in becoming close friends with her client, which is a sign of professional error. In addition. Ms. Rosalind may spread the information about her negative experience, further damaging Ms. Cheney’s professional reputation.
Lastly, the disastrous end of the practitioner-client relationships has nullified all positive preliminary outcomes achieved during the therapy sessions. Moreover, Ms. Rosalind’s mental state has likely worsened, and her negative experience with the therapy may provoke mistrust toward other mental health practitioners. In this regard, Ms. Cheney’s inability to maintain balanced practitioner-client relationships within mutually comfortable boundaries had long-term negative implications for the helping relationship.
Social and Emotional Impacts of Practitioner-Patient Friendship
It is necessary to underscore that ethical standards do not prohibit practitioner-patient friendship. Moreover, such dual relationships may have beneficial social and emotional impacts. Reamer (2012) provides two examples of practitioners improving their client’s conditions through friendship. In the first instance, Mary Anne V., a counselor at a group psychotherapy practice, shared the necessary confidence with her 42-year-old client who wanted to abandon her career and pursue new opportunities (Reamer, 2012). The counselor self-identified with the client’s dilemma, which allowed her to provide meaningful advice. At the same time, Ms. V was wise to befriend her client only at the conclusion of the counseling (Reamer, 2012). In this example, one can see how warm, friendly relationships throughout the therapy facilitated positive social change for the client.
On the second occasion, Mark L., a social worker at an outpatient clinic, improved his and his client’s emotional condition through a dual relationship built on common interests. Similar to his client, Mr. L was a war veteran, disillusioned in life and career. Throughout the therapy, Mr. L and his client became quite close and eventually started a friendship that eased their emotional pain (Reamer, 2012). As such, the practitioner-patient friendship can serve as a powerful healing instrument if executed cautiously. Unfortunately for Ms. Cheney, she entered her client’s personal life too deeply and turned the potential benefit into harm.
Case Outcome in the State of Illinois
If Ms. Rosalind filed a formal complaint in Illinois, her case would likely be proceeded by the Illinois Department of Financial and Professional Regulation (IDFPR). In particular, Ms. Cheney’s actions would be reviewed by the State Medical Licensing Board, which advises the IDFPR (IDFPR, n.d.). In turn, the Board’s judgment would likely be based on the Standards listed in Section 1285.240 of the 1987 Medical Practice Act (Joint Committee on Administrative Rules [JCAR], n.d.). The Standards do not directly prohibit multiple nonsexual relationships, which corresponds with Standard 5 of the National Organization for Human Services (NOHS, 2015). However, the 1285.240 Section includes such formulation as immoral conduct (JCAR, n.d.). According to JCAR (n.d.), immoral conduct is committed in the course of practice, which is true in Ms. Rosalind’s case. In addition, immoral conduct’s definition is quite broad, as it includes any physician’s actions that might have violated common standards of decency or ethical principles commonly associated with medical practice (JCAR, n.d.). Therefore, the Board could revoke Ms. Cheney’s license on immoral conduct grounds, depending on the circumstances that led to an argument between Ms. Rosalind and Ms. Cheney.
Risk Minimization Strategies
The choice of risk minimization strategies in nonsexual dual relationships, such as physician-patient friendship, primarily depends on practitioners’ clinical experience. The less experienced practitioners should avoid engaging in multiple relationships (Corey, 2019). This category of healthcare professionals should perceive boundary in its traditional sense — as a line that separates right from wrong, the protector of privacy (Dailey, 2017). If one has doubts about befriending the patient, one should choose the safest course of action in order to prevent harm to the client.
However, the more experienced practitioners could utilize friendship with a client to achieve a mutually beneficial outcome. Ms. Cheney’s fault was not in befriending Ms. Rosalind but in the lack of caution and self-control. Nevertheless, it is important to consider whether the potential benefits outweigh the potential harm (Corey, 2019). There are few universally correct solutions in the practitioner-client dual relationships, so one should seek advice from experienced colleagues or supervisors in order to avoid serious, potentially career-ending errors. Therefore, one should always monitor their actions to prevent a swift descent down the slippery slope of unethical conduct.
References
Corey, G., Corey, M. S., & Corey, C. (2019). Issues & ethics in the helping professions. (10th ed.). Cengage Learning.
Dailey, A. C. (2017). Violating boundaries.Studies in Gender & Sexuality, 18(1), 13–18. Web.
Illinois Department of Financial and Professional Regulation. (n.d.). State Medical Licensing Board. Web.
Joint Committee on Administrative Rules. (n.d.). Section 1285.240 Standards. Web.
National Organization for Human Services. (2015). Ethical standards for human services professionals. Web.
Reamer, F. G. (2012). Boundary issues and dual relationships in the human services (2nd ed.). Columbia University Press.