Strategies for Navigating the Ethics of Dual Relationships and Termination
1. True or False: Most professional ethics codes explicitly forbid providers from engaging in dual relationships.
TRUE
FALSE
2. Which of the following reasons for terminating treatment is the MOST likely to be viewed as client abandonment?
The counselor thinks the client is difficult to work with due to a personality disorder.
The client is not benefitting from treatment.
The counselor informed the client that they will be leaving their job in 3 months and want to set up a transition plan.
The client no longer needs treatment.
3. Which of the following is MOST likely to be a helpful aspect of pre-termination counseling?
Limit the pre-termination counseling to a single session to reduce discomfort for the client.
Loosen the clinical boundaries so that the client knows they can establish a social relationship with you now that treatment is ending.
Emphasize the permanent ending to treatment so that clients can have a sense of closure.
Increase the spacing between the pre-termination counseling visits.
4. To determine whether a decision to enter a dual relationship is being made objectively, which of the following should you do?
Consult with a colleague about the situation.
Ask the client to put their consent in writing before entering into the dual relationship.
Weigh the risks vs. benefits to your career.
Move forward with the dual relationship if not explicitly prohibited in your code of ethics.
5. In which of the following situations has client abandonment occurred?
A provider recommends transferring a client to a specialty treatment setting because they lack the appropriate skills to effectively treat the person.
A provider recommends termination because the client has achieved all of their goals. The client wants to continue because they enjoy the provider’s company.
A provider tells a client during their session that they should not schedule any further sessions because the client doesn’t seem to be working hard enough.
A provider terminates treatment because the client threatened to hurt the provider and the provider’s children.
6. Your client no showed for their scheduled appointment. They have never missed a session in the four months you have been working with them. What should your FIRST response be?
Terminate treatment immediately.
Wait for the client to call to schedule another session.
Call the client to discuss the reason for the missed session.
Send the client a bill for the missed session.
7. When is the best time to begin addressing termination of treatment?
When the client’s attendance of sessions becomes sporadic
When the client indicates that they are ready to terminate treatment
At the point where progress toward treatment goals has been made
At the start of treatment as part of the informed consent process
8. A behavioral health professional who is providing services to a client runs into the same client at the grocery store one day. The client then introduces the therapist to their sister. Later, the therapist matches with their client’s sister on a dating app, and they have since started dating. True or false: This is a dual relationship.
TRUE
FALSE
9. You have provided notice to your employer that you will be leaving the company in 6 weeks. The intake worker just assigned you a new case. It is a woman who has experienced numerous losses and has severe depressive symptoms in relation to those losses. What is your ethical responsibility in this situation?
You should use a time-limited treatment so you can help the client make as much progress as possible during the next six weeks.
You should discuss with your manager your concerns about how the client may be negatively impacted when you leave, based on her symptoms and history.
You should encourage the client to request a different treatment provider from within your organization.
You should provide your manager with only 1 week’s notice that you are leaving the company so they will stop sending you new cases.
10. In which of the following situations is termination generally appropriate?
The client is not benefitting from treatment or can be harmed by it.
The client holds different values from you.
The client would prefer to have a social relationship with you.
The client forgot to bring their copayment to their recent session
11. A behavioral health provider is considering whether to accept their client’s invitation to attend the client’s graduation ceremony. The provider has evaluated the potential for harm to the client and the treatment relationship. They have consulted with a colleague to make sure they are evaluating the situation objectively. They have discussed the risks and benefits with the client. What additional important step does the provider need to take?
Ask the client to sign a waiver of liability in the event any harm comes to the client.
Request permission from their state licensing board to attend the graduation.
Document their thought process and the other steps they have taken to evaluate this.
Transfer the client to another provider before attending the graduation.
12. Which of the following types of dual relationships is likely to involve the highest level of risk?
Supervising a trainee who shares your clinical interests
Exchanging a small token or gift when a client is ending therapy
Buying your groceries at a store where your client works as a cashier
Hiring a client to work for your practice in exchange for treatment
13. A client informs the provider treating her for a year that she has fallen in love with him. The provider is attracted to his client and would like to have a relationship with her. He arranges for her care to be transferred to another provider, so that they can then begin dating. Which statement is accurate?
The provider is involved in a sequential dual relationship even though he transferred the woman’s care to another provider.
It would not constitute a dual relationship for the social worker to date his client, as long as she is first linked with a new provider.
The social worker’s behavior is a boundary crossing, but not a boundary violation.
This cannot be construed as a dual relationship since the romantic interest was first initiated by the client.
14. Which of the following is the best precautionary measure to avoid problematic dual relationships?
Be sure to refrain from all boundary crossings.
Refer clients who seem to struggle with boundaries to another provider.
Enlist consultation from a trusted and experienced colleague.
Ensure your actions are consistent with the client’s wishes.
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