Heading off boundary problems: clinical supervision as risk management.
The effective management of risk in clinical practice includes steps to limit harm to clients resulting from ethical violations or professional misconduct. Boundary problems constitute some of the most damaging ethical violations. The authors propose an active use of clinical supervision to anticipate and head off possible ethical violations by intervening when signs of boundary problems appear. The authors encourage a facilitative, Socratic method, rather than directive approaches, to help supervisees maximize their learning about ethical complexities. Building on the idea of a slippery slope, in which seemingly insignificant acts can lead to unethical patterns of behavior, the authors discuss ten cues to potential boundary problems, including strong feelings about a client; extended sessions with clients; gift giving between clinician and client; loans, barter, and sale of goods; clinician self-disclosures; and touching and sex. The authors outline supervisory interventions to be made when the cues are detected.
Walker
R
R
Department of Psychiatry at the University of Kentucky College of Mediccine, Center on Drug and Alcohol Research, Lexington 40506-0350, USA. jrwalk0@pop.uky.edu
Clark
J J
JJ
D004995:Ethics, Professional; D006801:Humans; D008318:Malpractice; D010348:Patient Care Team / Q000592:standards*; D011369:Professional-Patient Relations; D011613:Psychotherapy / Q000592:standards*; D012307:Risk Factors; D012308:Risk Management