The counselor should address issues at the time they occur with the patient and:
acknowledge importance of feelings, emphasize the provider-patient relationship and the importance of maintaining objectivity"; and finally "emphasize that the rejection of a requesting behavior does not imply a lack of caring." (Barbour, 2007)
If the boundary issues affect the ability of the counseling in providing objective and compassion care, the counselor should seek professional counseling for self and possibly for the patient and their family. (Barbour, 2007)
The work of Michael Liimatta entitled: "Issues of Personal Boundaries in Counseling: Part I" states that many times the phrase 'professional distance' is taken by people to mean cold and uncaring but in reality 'professional distance' is quite opposite of uncaring and is actually a strategy geared toward protecting the client from the counselors loss of objectivity." (Liimatta, 2001)
IV. Maintaining the Delicate Balance between Rapport and Professional Boundaries delicate balance must be maintained between rapport and professional boundaries so that the impact of the effectiveness of counseling is not negatively affected. Professional Boundary standards are of the nature of:
5) Emotional/Psychological; and 6) Personal Integrity.
Self-disclosure is a strategy utilized by counselors in developing rapport with their patients however, "Little research has been conducted on the effects of self-disclosure on the attitudes of patients and therapists." (Reexamination of Self-Disclosure, 2007)
Self-Disclosure: Attitudes among Patients
The following facts were stated in the findings of a 1974 study on therapist self-disclosure and patient attitudes:
There was no relationship found between the willingness of the therapist and the patient to self-disclose;
The expectations of the patient concerning the appropriateness of the self-disclosure of the therapist were influenced their actions in the event of self-disclosure;
Patients who expected self-disclosure from their therapists revealed more information to the therapist who self-disclosed less;
Patients who did not expect therapist disclosure revealed less information to "highly disclosing therapists." (Reexamination of Therapist Self-Disclosure, 2001; paraphrased)
Several types of therapy present self-disclosure opportunities and as well, self-disclosure may "contribute to the effectiveness of peer models..." (Reexamination of Therapist Self-Disclosure, 2001) Cognitive behavioral therapy and social skills training provides the opportunity for use self-disclosure strategies to "model coping strategies and problem-solving techniques." (Reexamination of Therapist Self-Disclosure, 2001)
In psychopharmacologic treatments, self-disclosure has been found to:
1) Increase rapport;
2) Enhance the therapeutic alliance; and 3) Increase medication compliance. (Reexamination of Therapist Self-Disclosure, 2001)
This report ends with the warning that: "Clinicians should recognize the benefits of self-disclosure as well as its dangers." (Reexamination of Therapist Self-Disclosure, 2001)
V. Respectful Persistence
The work entitled: "The Art and Science of Respectful Persistence" states that respectful persistence is:
subtle skill" which "strikes a delicate balance between diligently pursuing a prospect and always maintaining a high level of respect for the boundaries and wishes of the prospect." (Expert Business Development, 2007)
An important part of the training of respectful persistence is to "use each contact with the prospect as a way to underscore how important, satisfying and appropriate a relationship between our client and the prospect would be." (Expert Business Development, 2007) the key to achievement of this balance is "to be able to quickly engage the prospect on an emotional level and build rapport and trust."
VI. Current Research on Strategies and Interventions for Maintaining Rapport and Boundaries Simultaneously
The work of Nancy a. Bridges entitled: "The Vulnerable Therapist: Practicing Psychotherapy in an Age of Anxiety" "explores therapist and client vulnerability in a professional context that is increasingly (and unethically) rule-based." (1998) Bridges holds that "ethics rules are increasingly limiting therapeutic possibilities for clinicians and clients." (Bridges, 1998) Bridges writes of the "crisis of meaning in the mental health professions" and the inherent limitations that exist in rule-based ethics." (Bridges, 1998) in other words, questions remain in this area and in order that the professional counselor not be, found lacking in this area the professional counselor will be appropriately education and have proper training in the competence area of their practice.
It is critical that the professional counselor keep their knowledge current through continuing education. Finally, the professional counselor will possess the ability to "recognize the limitations of their own "knowledge and expertise." The clinician may be competent in several areas, but will not be competent in every area and "it becomes vital for clinicians to recognize and limit their practice to areas for which they have sufficient expertise to perform in a competent manner."(Bridges, 1998) it is important that the clinician not become "overzealous in the successful application of a particular technique and lose sight of the delimiting boundaries of these procedures." (Bridges, 1998) This reiterates the importance of education and training for the clinician and an effective practice.
VII. Implications for Counselors: Rapport/Boundaries Imbalance
The work of Galeazzi, Elkins, and Curci (2005) relates that mental health professionals "may be at particular risk of being victims of stalking." The reason for this is stated by Galeazzi, Elkins and Curci to be as follows:
Psychiatrists and psychologists are the professionals most likely to be stalked, possibly because aspects of the psychotherapeutic relationship can produce misunderstandings about the nature of the intimacy generated and about appropriate boundaries in this type of relationship." (Galeazzi, Elkins, and Curci (2005)
This type of situation is only one of the considerations that the counseling professional must consider when interacting with clients. Ethical considerations of doing no harm is followed by organizational, legal, professional, moral, and spiritual considerations in terms of morality and ethical professional behavior. Setting clear boundaries is critically important. Added to this is the need for development of rapport with the client and all of this requires a very delicate balance on the part of the counselor. The counselor should at all times be aware of the patient's condition(s) and that all behavior and communication between the counselor and client be of the nature that is warm, caring, concerned, and yet that the behavior is not of the nature that will blur the lines between professional and personal caring.
Blurring of the lines may likely result in some event that would reflect badly on the counselor and that would taint the counselor-client relationship in an unethical light. While this may occur even with the counselor following all ethical and regulatory guidelines, the chance of this occurring will be greatly lessened by adherence on the part of the counselor.
Recommendations Arising from this Study
The literature relating to the necessity of a balance between rapport and professional boundaries is sadly lacking and most specifically in terms of current research therefore, it is the contention of this researcher that research should be applied in this direction in order that the current knowledge base be refreshed and that any new findings might be added to this research.
Methodology of this Study
The methodology of this study has been of a qualitative nature in which data collection and analysis has been accomplished through a review of the literature in this subject area and analyzed interpretively.
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