- What violation occurred? Consider ethical principles and obligations.
The four ethical principles in forensic psychiatry include the respect for autonomy, justice, non-maleficence and beneficence. In the case of Sean and Emma, Sean was assigned two-hour sessions with Emma, however, he repeatedly violates the clinical rules by staying longer than the assigned time and also dropped her home and bought dinner for her. Sean provided Emma with his personal mobile number and they regularly interacted to discuss the difficulties that she was facing reducing her presentation at the local emergency departments. This was a breach of the principle of justice that promotes fair and equitable distribution of the healthcare resources among the people and ensures that each person is presented the support which is an equal share, according to the need and according to the merit and contribution. Emma was receiving care and treatment that was more than what was designated for her and this was against the principle of distributive justice. Other than this, the behavior of Sean as a junior clinician was also violating various clinical rules like not sharing the personal mobile number with the clients and not exceeding the designated time assigned for each client. While it is important for the clinicians to act the benefit of the clients, it is also important to promote the Welfare of the clients and by providing excessive support to Emma Sean was acting against the ethical principle of beneficence (Sen, Gordon, Adshead, & Irons, 2007). The boundary violation in the clinical setting can be identified in this case because of the ignorance of Sean along with the moral weakness. Even though Sean did not establish any exploitative or sexual relationship with Emma, his decision to exceed the assigned time and also communicate with her informally, outside the clinical setting was a boundary violation (Aravind, Thasneem, & Krishnaram, 2012).
- What makes this a boundary violation? What actions were or were not taken that makes this a violation.
Boundary violation is defined as any act where a therapist tries to misuse his power for exploiting the client for his own benefit. These violations are illegal and unethical. The boundary violations can be momentary or ongoing. In the case of Sean and Emma, a series of bad decisions were made leading to a huge error by Sean. These errors lead to a boundary violation because Shaun did not recognize how extending the assigned time and sharing the personal mobile number for informal communication and providing counseling services outside the forensic community clinic would be integrated by Emma. His failure in maintaining clear time boundaries made Emma misinterpret the therapist-client relationship, which made Emma presume that Shawn was her friend and not a therapist. Over time, Emma became very comfortable discussing her difficulties over the call and staying late at the clinic with Sean. All these actions make this a boundary violation. However, there was no sexual boundary crossing in this case. The repeated non-sexual issues related to the boundary and the inability of Sean to avoid transpiration made this a violation and lead to Emma taking an advantage and lodging a fake complaint of Sean sexually exploiting her even though there was no sexual boundary crossing or violation of any form (Aravind, Thasneem, & Krishnaram, 2012).
- What factors contributed (systems and individual; short and long term) to allowing this situation to come to a head?
The system factors that contributed to this situation getting out of hand included Emma’s condition of depression, rage and anxiety. Emma was in a physically abusive relationship which made Sean feel bad for her and violate the clinical rules to help her out. Emma’s poor financial condition was also a factor that led to Sean going out of his way to help her and reduce her visits at the local emergency departments. The individual factors that led to the situation included the lack of competence of Sean as a clinician and his inability to practice ethical behavior and master his responsibilities. In the short term, Sean violated the clinical rules repeatedly by extending the two-hour sessions with Emma. He drove her home in his work car so that she would not have to catch the late-night train. This was a boundary violation because he was not aware of how Emma was interpreting his decisions and actions (Dalzell, 2018). Sean also bought food for Emma when dropping her home. His decision of giving his mobile number to Emma was another clear boundary violation evaluation of the clinical rules. In the long term, Sean made various mistakes, even though he felt that he had to do this to bring about positive improvements in the behavior of Emma. Sean’s behavior was a disruption of the accepted and expected social and psychological boundaries and it contributed to deviating them from the basic goal of treatment making their interactions non therapeutic (Hermansson, 1997).
- Discuss four likely harmful outcomes of this boundary violation.
The four likely harmful outcomes of boundary violations in the case of Sean and Emma include:
- Sean established dual relationship with Emma. This invariably interfered with the clinical work and his duty of engaging with her and providing her medical attention. The likely outcome of this violation is that Emma would misinterpret his actions and get emotionally and sexually attached to him.
- Another likely harmful outcome of boundary violation would be that Emma would start expecting the same service and attention from all the care providers which is unethical and unfair. Sean was regularly driving for home and also buying food for her. This boundary violation would result in Emma expecting similar favors from all her care providers (Glass, 2003).
- The non-sexual boundary violation in the case of Sean and Emma could have possibly resulted in making the anxiety, depression and rage issues faced by a more even more severe when Sean would start withdrawing his attention and feeling overwhelmed by her demands of being available on call all the time and helping her out in every situation.
- Finally, the likely harmful outcome of this boundary violation would be Sean losing his job because of the fake sexual exploitation complaint lodged by Emma because he did not keep his supervisor informed extended sessions and their conversations over the personal phone (Hook & Devereux, 2018).
- Discuss four ways in which this boundary violation could have been averted, while still maintaining responsive service delivery.
Sean could have continued to provide responsive service delivery to Emma without getting involved in the boundary violations through the following ways:
- Sean should have avoided providing direct advice and guidance to Emma about her personal life and getting involved in her life by strictly sticking to the time that was assigned to her and seeking assistance from his supervisor if Emma was going through excessive stress and difficulty and she required additional help even after these sessions (Plaut, 2008).
- This situation could have been avoided if Sean maintained clear boundaries and did not offer Emma with any additional help like dropping her home or buying food for her even though he was aware of her financial difficulties. He could have offered help in the form of getting her connected with any source that could provide gainful employment to her instead.
- Sean could have avoided the situation by not sharing his personal mobile number with Emma because this lead to further blurring the boundaries between them and made him accessible to her throughout the day.
- Finally, Sean should have informed his supervisor about his mistakes once she started feeling overwhelmed because of excessive demands by Emma and requested the appointment of another clinician for her immediately (Ruffalo, 2019).
Aravind, V., Thasneem, Z., & Krishnaram, V. (2012). Boundary Crossings and Violations in Clinical Settings. 34 (1), 21–24.
Dalzell, H. (2018). Boundaries in Mental Health Treatment.
Glass, L. (2003). The Gray Areas of Boundary Crossings and Violations. American journal of psychotherapy, 57 (4), 1-16.
Hermansson, G. (1997). Boundaries and boundary management in counselling: The never-ending story. British Journal of Guidance and Counselling , 25 (2), 133-146.
Hook, J., & Devereux, D. (2018). Sexual boundary violations: victims, perpetrators and risk reduction. 24 (6), pp. 374-383.
Plaut, S. (2008). Sexual and nonsexual boundaries in professional relationships: Principles and teaching guidelines. Sexual and Relationship Therapy , 23 (1), 85-94.
Ruffalo, M. (2019). Nonsexual Boundary Violations in Psychotherapy: A Primer.
Sen, P., Gordon, H., Adshead, G., & Irons, A. (2007). Ethical dilemmas in forensic psychiatry: two illustrative cases. 33 (6), 337–341.