Exploring the edges: boundaries and breaks

In this article, we examine conceptual and practical issues pertaining to relationship boundaries within the helping profession. Although our focus is primarily on relationships between mental health professionals and clients, there are considerable implications for a new approach to ethically structuring and understanding the construct of "required distance" in many human-interactive professions, such as teaching, religious leadership, public administration, and others. We define the concept of boundary as applied to human relationships, provide examples of boundary breaks, and raise questions regarding how to evaluate the significance and morality issues raised by specific boundary breaks. Questions and dilemmas are presented regarding boundary setting and accidental or deliberate boundary breaking. Representative dangers present in boundary breaks are identified, and examples are provided. Possible beneficial outcomes are also discussed. Finally, a suggested protocol for assessing a proposed boundary break is provided, much of which is drawn from the work and thinking of Laura Brown, applied more generally in this article, with additions from our perspectives.     

ETHICAL ISSUES IN FEMINIST THERAPY

This article describes ethical issues that have emerged from the past decade of feminist therapy practice in response to context-specific ethical dilemmas. The model of feminist therapy practice within small communities is used to illustrate the types of problems encountered and strategies for ethical practice used by feminist therapists. Two topics are examined in detail: boundary overlap between therapist and client, and role-related strains inherent in feminist therapy practice. The Feminist Therapy Institute (FTI) Ethical Code is drawn upon as a source of norms for ethical feminist practice, and specific examples are related to statements from the FTI Code regarding self-care and management of over-lapping relationships.     

Boundary Issues and Multiple Relationships in Genetic Counseling Supervision: Supervisor,Non-supervisor,and Student Perspectives

Boundary issues and multiple relationships potentially affect all supervision interactions. Boundary crossings are departures from the strictest professional role and may or may not benefit supervisees. Boundary violations are outside common practice and may place supervisees at significant risk. Multiple relationships occur when supervisors concurrently or consecutively hold two or more roles with supervisees. Studies in other fields indicate supervisors and supervisees may be uncertain about professional conduct regarding these issues. In this study, genetic counselor supervisors (n?=?126), non-supervisors (n?=?72), and genetic counseling students (n?=?129) completed an anonymous survey investigating four major questions: 1) Are various boundary issues and multiple relationships perceived as differentially appropriate? 2) Do supervisor, non-supervisor, and student perceptions differ? 3) What challenging situations have respondents experienced? and 4) What management strategies did they use? There was general agreement among groups in their appropriateness ratings of 56 hypothetical supervisor behaviors, although supervisor ratings tended to reflect stricter boundaries regarding the appropriateness of interactions than student ratings. A majority rated unavoidable boundary crossings and supervisor multiple relationships involving an academic relationship as most appropriate, and romantic/sexual multiple relationships and/or boundary violations as least appropriate. Analysis of respondents’ actual challenging situations revealed many involved boundary violations, placed students at risk of harm, and often resulted in student compliance.     

What Does It Mean to Be Relational? A Framework for Assessment and Practice

The authors begin with a question regarding how to better draw upon relational thinking in making case assessments and treatment plans. They first address issues regarding the cultural construction of self and relationships, integrating women's psychology, family systems, and collectivist culture literatures within a discussion of power. Then they present a heuristic framework for how individuals orient themselves within relationships that includes two dimensions--focus and power--and evolves out of the social context. From these two dimensions, a typology of four basic relational orientations is presented: position directed, rule directed, independence directed, and relationship directed. Case examples from couple's therapy and suggestions for practice are provided.     

From brand aversion or indifference to brand attachment: Authors' response to commentaries to Park,Eisingerich, and Park's brand attachment–aversion model

The primary purpose of our target article was to theoretically argue and empirically demonstrate that it is possible to elevate the customer–brand relationships to the desired level of human relationships by offering three types of self-relevant benefits. In this response, we discuss the major comments provided by each set of commentators, which are insightful and thought-provoking. It is our hope that this dialogue will open up a new avenue for future research regarding the nature and management of customer–brand relationships.     

Psychology and "ordinary language"—a critique of Smedslund

This article takes up methodological issues of the kind raised by Jan Smedslund in earlier issues of this journal, concerning the status of psychological enquiry as a discipline. Arguments are presented which aim to show that Smedslund has failed to establish the thesis that all generally valid theoretical statements in psychology are explications of conceptual relationships embedded in ordinary language, i.e., analytic statements. Some specific examples of what Smedslund takes to be "ordinary language theorems" are examined. Doubts are expressed concerning the validity of the proof procedure Smedslund employs in the "demonstration" of a number of his alleged theorems. Finally, it is argued that the results produced by the situation-bound and culture-bound empirical research of the psychologist need not be viewed as "arbitrary" in Smedslund's sense of that term.     

GUILT AND THE SCIENCE OF EMOTION: HOW DOES PRAYER FIT?

This article engages sources regarding evolutionary development of guilt (Richard Joyce's The Evolution of Morality, Jesse Prinz's Gut Reactions, and others) and how they can be used to dialogue with material on the alleviation of guilt in the Christian tradition using examples in the work of Anselm of Canterbury and John Chrysostom. This raises a few key questions. If guilt is an evolutionary trait created to build reputation and relationship, how does this mesh with some theological approaches to solutions for guilt? To be more precise, guilt possibly evolved to create a motivation for beneficial communal actions, and necessitates belief in the authority of the rules that one breaks to induce it. That said, does religion play a role in awareness of one's guilt, while also providing a solution to that guilt? The possibilities are explored in this article as they relate to issues of repentance, atonement, and prayer.     

Multiple relationships: does the new ethics code answer the right questions?

The new "Ethical Principles of Psychologists and Code of Conduct" (American Psychological Association, 1992) presented expanded attempts to clarify the ethical issues regarding multiple relationships and to provide useful guidance for psychologists. This article proposes that the new code fails to address adequately two basic questions necessary to provide psychologists with clear guidance: (a) What are multiple relationships? and (b) When do multiple relationships constitute unethical conduct? The article offers a definition of multiple relationships and identifies several dynamics operating within a professional relationship that are likely to be adversely affected by the imposition of a secondary relationship. Unethical multiple relationships are defined. Finally, the article suggests additions to the new code that would enhance its utility for psychologists.     

Environmental Illness/Multiple Chemical Sensitivities:

Recent attention has focused on a hidden disability usually referred to as Multiple Chemical Sensitivities (MCS), Environmental Illness (EI), or Ecologic Illness, and involving detrimental effects on multiple bodily systems in response to exposures to chemicals in levels that have been "generally regarded as safe" (GRAS). This article will briefly describe MCS/EI as a disability, with emphasis on the impediments to a productive life for persons who experience this syndrome. Economic and psychological issues which are likely to be present as a result of being forced to face life with this hidden and unacknowledged problem are discussed. Political and disability issues are discussed, and examples are provided of women coping with the various aspects of this illness. Therapists who wish to be supportive to this population are offered suggestions for caregiving.     

Boundary Considerations Between Doctoral Students and Master's Students

Counselor educators have a responsibility to teach students about boundary issues and multiple relationships. In addition to counselor–client concerns, there has been increased attention to faculty–student multiple relationships. Like faculty, doctoral students in counselor education programs often engage in roles with master's‐level students in which they hold a position of authority. This article reviews the professional literature on multiple relationships and boundary issues within counselor preparation programs and applies the research to boundary considerations between graduate students. Potentially fruitful areas for research are also suggested.     

A Bayesian approach to estimating variance components within a multivariate generalizability theory framework

In many behavioral research areas, multivariate generalizability theory (mG theory) has been typically used to investigate the reliability of certain multidimensional assessments. However, traditional mG-theory estimation—namely, using frequentist approaches—has limits, leading researchers to fail to take full advantage of the information that mG theory can offer regarding the reliability of measurements. Alternatively, Bayesian methods provide more information than frequentist approaches can offer. This article presents instructional guidelines on how to implement mG-theory analyses in a Bayesian framework; in particular, BUGS code is presented to fit commonly seen designs from mG theory, including single-facet designs, two-facet crossed designs, and two-facet nested designs. In addition to concrete examples that are closely related to the selected designs and the corresponding BUGS code, a simulated dataset is provided to demonstrate the utility and advantages of the Bayesian approach. This article is intended to serve as a tutorial reference for applied researchers and methodologists conducting mG-theory studies.     

Duty-to-warn guidelines for mental health counselors

There are few clear definitive guidelines for counselors to implement regarding duty-to-warn cases. In addition, ethical codes do not specifically address duty-to-warn issues. A tentative model to use as a guide in making clinical judgments in such cases is provided as well as case examples to exemplify possible ethical dilemmas in the practice of counseling.     

A SAS macro for statistical power calculations in meta-analysis

Although statistical power is often considered in the design of primary research studies, it is rarely considered in meta-analysis. Background and guidelines are provided for conducting power analysis in meta-analysis, followed by the presentation of a SAS macro that calculates power using the methods described by Hedges and Pigott (2001, 2004). Several detailed examples are given, including input statements and output. Practical issues in the application of power analysis to meta-analysis are discussed. The macro and examples may be downloaded as supplemental materials for this article from brm.psychonomic-journals.org/content/supplemental.     

Ethical Issues in Mentoring Doctoral Students in Clinical Psychology

Ethical issues abound in any relationship that is defined by differences between the parties in rank, status, and power. Such is the case in the relationship between a doctoral student in clinical psychology and his or her mentor. In this article, we examine several potential areas of ethical concern within the mentor-student relationship. We present a series of vignettes and our analyses of the issues that arise within them as we examine romantic dual relationships, nonromantic dual relationships, and other ways in which the mentor's power may be intentionally or unintentionally misused for personal gain. We also look at several examples of unhelpful mentoring. Problematic situations often arise when there is the potential for loss of objectivity by either party or exploitation of the student by the mentor. Although the relationship with one's mentor may be one of the most important and gratifying aspects of the graduate school experience, both mentors and students should keep in mind that behavioral choices within this relationship are often complex ones that require forethought, self-monitoring, and discussion between the parties.     

Therapy with Refugee Families: What Is a “Good” Conversation?

This article addresses the question of what is a “good” conversation by analyzing “poor” conversations. During a project on family therapy with refugee families, we often experienced what we labeled as “poor” conversations. We present examples of a variety of such conversations, which we then analyze with reference to therapeutic maps and central concerns of the therapists. We describe four patterns of therapist/client relationships that emerged from this analysis. The main focus of our discussion is to clarify when “poor” conversations may be an important part of the therapeutic process, and when and how they should be avoided. We believe that the issues we raise are central to therapeutic work in general and not just to therapy with refugee families.     

NEW VOICES, NEW VISIONS

This article proposes an alternative model for psychological inquiry based in the experiences of lesbians and gay men. I propose that there are three elements that cross-situationally define a lesbian and gay reality: biculturalism, marginality, and normative creativity. Each of these elements is explored with examples of how these perspectives might alter the way that certain dominant notions about human relationships are understood. The article closes with questions regarding the application of this lesbian and gay paradigm to methodologies for inquiry. The relationship between a lesbian/gay paradigm for psychology and feminist questions regarding epistemology is also explored.     

“Can We Talk?”: Boundary Crossing and Sexual Misconduct in Seminary Teaching

This article explores a variety of personal and professional boundary issues encountered by seminary faculty. The authors contend that boundary crossing is inevitable in contemporary theological education, which is structured such that professors engage in multiple roles with students as they attend to the education of the whole person. Guidelines are reviewed for minimizing risk to students and professors. Topics include life as a community member, student‐faculty friendship, and romantic relationships. Attention to work/life balance is seen as critical to the prevention of misconduct. The article ends with a call for continued conversation as well as institutional accountability and change.     

The role-taking interview: an assessment technique for adolescents

This paper presents the Role-Taking Interview (RTI) as a tool for assessing the subjective experiences of adolescents in crisis. The RTI is intended as an adjunct to traditional assessment approaches and can provide clinicians with information regarding adolescents' perceptions of social relationships. A five-step approach for utilizing the method is presented along with its theoretical basis, rooted in role theory and psychodramatic concepts. Illustrative case examples are provided.     

Complexity of ethical decision making in psychiatry

Psychiatric residents and psychiatrists have little difficulty in making judgments about a clinical course of action to take with patients. However, making ethical clinical decisions is more challenging, because psychiatric residents are usually provided little formal training in ethics. Further, many ethical dilemmas are complex, requiring knowledge of the psychiatric profession's ethics code, moral principles, law, and practice standards and of how they should be weighed in the decision-making process. The purpose of this article is to demonstrate this complexity in regard to the identification of potential ethical dilemmas, understanding the issues that these dilemmas raise, and formulating potential solutions to them. Two common but important areas of treatment in which ethical dilemmas arise (informed consent and competence of care) are used as examples for our presentation. The article demonstrates that to successfully engage in ethical analysis in psychiatry is impossible without substantial formal training in the process.     

Treatment of Deaf Clients: Ethical Considerations for Professionals in Psychology

Providing therapy to deaf clients raises important ethical considerations for psychologists related to competence; multiple relationships and boundary issues; confidentiality; assessment, diagnosis, and evaluation; and communication and using interpreters. In evaluating and addressing these, psychologists must consider the American Psychological Association’s Ethics Code and other relevant issues (e.g., Americans with Disabilities Act) necessary to provide ethical treatment. The current article provides background, ethical considerations, principles and standards relevant to the treatment of deaf clients, and recommendations to support psychologists, training programs, and the field. Psychologists have the responsibility to guarantee that the benefits of mental health treatment are fairly and justly provided to this traditionally underserved population.