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NATURE AND IMPORTANCE OF PROFESSIONAL RELATIONSHIP

IN COUNSELLING

AN ASSIGNMENT SUBMITTED TO

Dr. ASGHAR ALI SHAH

SUBMITTED BY
SYEDA HUMA IFTIKHAR

NATURE OF PROFESSIONAL HELPING RELATIONSHIP IN COUNSELLING


Defining the differences between helping behavior and a helping relationship lies in the nature of
the interactions between the parties. At one time or another everyone has provided support or
advice to friends. A friendship is casual in nature with the tone of availability and support.
Friendships are not bound by a code of ethics, but by an understanding and desire to build the
relationship (Young, 2008). Usually advice is freely given, with little thought of the potential
outcome, and the conversation is reciprocal. What may come easily for the friend with a
sympathetic ear would not lend favorably in a professional helping relationship.
A professional helping relationship in counseling or psychotherapy has a fairly consistent nature.
Deciding how one wants to practice, either privately or part of an organization, and determining
the focus of the practice as well as the type of population one wants to serve is only the first step
of building this professional helping relationship. It has a purpose and can be entered into for
different reasons.
The person seeking this relationship could be looking for help with a problem or specific issue
needing further understanding, resolution, and closure, or it can be a relationship that begins with
a referral from another provider. "Every client is not the same. Each one brings with them not
only their own issues but their own heritage and cultural background that influence their belief
system, values and ideas that may be foreign to the counsellor or therapist. A challenge that the
therapist may face is in understanding how they feel about dealing with a person with a belief
system different from their own. Effective helpers come to understand the personal cultures of
clients (Eagen, 2002) and therefore should spend some time searching their own personal
beliefs and values. A counselors personal beliefs and value systems can influence the
interactions that they have with their clients. Eagen (2002) speaks to this interaction and goes on

to say that understanding clients different approaches to developing and sustaining


relationships is important knowing where one stands in their personal beliefs and being
sensitive to those differences helps the counselor enter the relationship without judgment to value
and respect the individual.

Characteristics of a professional relationship


Mark Youngs Learning the art of Helping listed characteristics of a professional relationship.
They are:

There is a liking or at least respect [of the client].


The purpose of the relationship is the clients issues.
There is a sense of teamwork as both helper and client work toward a mutually agreed

upon goal.
There is a contract specifying what will be disclosed outside of the relationship. Safety

and trust are established.


There is an agreement about compensation for the helper.
There is an understanding that the relationship is confined to the counseling sessions and

does not overlap into personal lives.


As a contractual relationship- the relationship can be terminated at anytime.

Elements of a Quality professional Relationship


In order for a quality professional relationship to be established it is necessary for it to contain
certain elements including:

Respect

Empathy

Understanding

Clear boundaries

Trust

Openness

Self awareness

Genuineness

Supportive

Warmth

Professionalism

Confidentiality

Good rapport

Good communication

Acceptance

The importance and benefits of a Therapeutic Relationship


The benefits of a therapeutic relationship include:
* If the client trusts the therapist they will be far more likely to accept any advice or guidance.
* Such a relationship encourages people to be more open about their inner thoughts and feelings.
The client feels safe so they are happy to divulge such information.
* Empathy allows the therapist to better understand where the client is coming from
* A professional relationship is empowering to the client. They will tend to view the therapist
more as a resource than as somebody who tries to tell them what to do.
* The client walks away from such an encounter feeling like somebody has really listened to
them.
FUNDAMENTALS OF PROFESSIONAL RELATIONSHIP:
Empathy
Empathy is a natural response to being with another person. Emotional empathy is responding
to anothers feelings (Young, 2002). Empathy facilitates connections with a client because it
shows that the therapist understands the persons viewpoint. It is an important part of the
therapeutic process and is seen as a basic value that informs and drives all helping behavior
(Eagen, 2002). The use of empathy, allows the client to understand that the counselor is present
and really focused on what is being said while validation and normalizing communicates to the

client that they are in their own way unique, but not so unique that they are alone in whatever
may be going on for them.
For example, a client comes into therapy stating that her sons constant negative reactions to her
requests are beginning to make her feel like a failure. An empathic response would be to reflect
back to the client what has been said, because the counselor has listened to the experience and
can reflect the emotion while describing the feeling, allowing the client to feel heard and
understood.
Silence
The effective use of silence as a way of listening to a client allows presence without intrusion. A
form of non verbal communication attentive silence can be used when a client is given space to
reflect . . . and take time to think (Young, 2008). Being able to hold the safe space and be quiet
when the client is not speaking can present some challenges to a therapist. Being comfortable
enough to allow the client to reflect, feel or view a problem or situation in a new way can all take
place in moments of silence, and when the client speaks again, a significant breakthrough in his
thinking may occur (Glasser, 2004).
As a professional, one needs to understand the nuances of their interaction with others as they
determine how to help without hurting and support to those in need. Learning how to become an
effective helping professional is a process of gaining knowledge from others and looking closely
at self. Young (2008), offered advice on this stating a reflective practitioner requires a
commitment to personal awareness of your automatic reactions and prejudices and taking time to
think on them

Privacy and confidentiality with family or group


Privacy is the clients right to keep the counseling relationship a secret (Cottone & Tarvydas,
2007). Therefore all aspects of the relationship fall under this definition. It is the counselors
responsibility to ensure that all information shared is held strict confidence, and are guaranteed
to be held in confidence unless the client approves the release of the information shared within
the session. Confidentiality is the obligation of the professional to respect the privacy of clients
and the information they provide (Cottone & Tarvydas, 2007).
At the start of the professional relationship it should be made clear to client the limits of
confidentiality. These specific situations include:

When presenting as a danger to self or others

Duty to warn another individual of an identifiable threat

Duty to protect said individual by some intervention or help

Any disclosed information about child or elder abuse or neglect

When questioned by parents or guardians when working with a minor

Consultation with other professionals or students of counseling

Breaking confidentiality outside of these limits can be devastating to a therapeutic relationship.


Psychologists have a primary obligation and take reasonable precautions to protect confidential
information obtained through or stored in any medium (APA, 2002), including files, internet or

email correspondence and voice mail. Although therapists are human and subject to lapses of
awareness and misguided judgments there is little room for such a grievous error.
For a practice that involves more than one individual as in the case for family or group therapy it
is important that all people participating in the therapy understand their roles and their
relationships with all parties (Fisher 2009). Since the therapeutic relationship is built on trust, a
client that does not know the limits of the counselors sharing of information can be put in a
potentially awkward or unsafe situation. It is the counselors job to explain roles clearly through
the process of obtaining informed consent because all clients have a right to know in
advance . . . any limitation of privacy [and] confidentiality (Pope & Vasquez, 2007).
Personal and professional growth
Competence is the cornerstone of ethical practice; ethical behavior is contingent on
intellectual and emotional competence .

A Practitioner should strive for constant personal and professional growth, but needs to
be aware of personal limitations and stress while balancing multiple responsibilities and
incorporate a system of self care.

Refrain from initiating an activity when they know or should know that there is a
substantial likelihood that their personal problems will prevent them from performing
their work related activities in a competent manner.

Become aware of personal problems that may interfere with their performing workrelated duties adequately, take appropriate measures such as obtaining perofessional

consultation or assistance, and determine whether they should limit, suspend or terminate
their work-related duties.

A simple formula to help achieve balance includes personal awareness, the counselor
knowing the limits of his/her skills, participating in on going training, maintaining
supervision to discuss ethical concerns and client progress, and know about current
research and findings.

"Therapy represents a complex power relationship" (Anderson & Handelsman 2009). The
counselor should be aware of his/her own system of judgments and as these and personal
values are an important part of upholding ethical principles. He/she also needs to be
aware of his/her clients values remembering to be respectful and careful not to impose
personal beliefs onto the client. The counselor holds all the responsibility to the client and
all interactions need to remain within that framework.

Maintaining a sense of balance and self care is vital to maintain an integrated and
cohesive lifestyle. The therapist needs to determine obligations and life choices that are
true to the self, looking deeply at beliefs, values and virtues held to know where one
stands. Having the internal battle for good or bad, right or wrong is not conducive to good
mental health. Decisions made impact not just the therapist and client, but families,
spouses, partners and colleagues.

Ethical considerations and responsibilities

"Ethical awareness is a continuous active process" . As a practitioner strives for personal and
professional growth they need to be aware of personal limitations, stress, and balancing multiple
responsibilities.
To ensure that therapists, clinicians, and counselors uphold high professional standards the
American Psychological Association (APA) developed the Ethical Principles of Psychologists
and Code of Conduct (ethics code). Serving as a guide to dictate procedural applications and
conduct within a therapeutic setting. Ethics standards set forth enforceable rules [and the fact
that] a given conduct is not specifically addresses by an ethical standard does not mean that it is
necessarily either ethical or unethical (APA, 2002).
The Code of Ethics is a document full of information including ethical standards for
confidentiality and privacy, and how a self care strategy can help a therapist avoid burnout and
making mistakes.

CHARACTERISTICS OF PROFESSIONAL BOUNDARIES


Boundaries are the framework within which the therapist/client relationship occurs. Boundaries
make the relationship professional, and safe for the client, and set the parameters within which
psychological services are delivered. Professional boundaries typically include fee setting,
length of a session, time of session, personal disclosure, limits regarding the use of touch,
and the general tone of the professional relationship. In a more subtle fashion, the boundary
can refer to the line between the self of the client and the self of the therapist.

The primary concern in establishing and managing boundaries with each individual client must
be the best interests of the client. Except for behaviors of a sexual nature or obvious conflict of
interest activity, boundary considerations often are not clear-cut matters of right and wrong.
Rather, they are dependent upon many factors and require careful thinking through of all the
issues, always keeping in mind the best interests of the client.
Who Negotiates the Boundaries in the Professional Relationship
In any professional relationship there is an inherent power imbalance. The therapists power
arises from the clients trust that the therapist has the expertise to help with his or her problems,
and the clients disclosure of personal information that would not normally be revealed. The fact
that services cannot be provided unless clients are willing to cooperate, does not change the
fundamental power imbalance. Therefore, the therapist has a fiduciary duty to act in the best
interest of the client, and is ultimately responsible for managing boundary issues and is therefore,
accountable should violations occur. Given the power imbalance that is inherent in the
professional/client relationship, clients may find it difficult to negotiate boundaries or to
recognize or defend themselves against boundary violations. As well, clients may be unaware of
the need for professional boundaries and therefore, may at times even initiate behavior or make
requests that could constitute boundary violations.

TYPICAL AREAS WHERE BOUNDARIES NEED TO BE MAINTAINED


There are a number of areas in which one has to maintain boundaries, that is, draw a line. Below
are some typical areas that can present difficulties.

Self disclosure:
Although in some cases self disclosure may be appropriate, members need to be careful that the
purpose of the self disclosure is for the clients benefit. A number of dangers may exist in self
disclosure including shifting the focus from the needs of the client to the needs of the therapist or
moving the professional relationship toward one of friendship. The blurring of boundaries can
confuse the client with respect to roles and expectations. The primary question to be asked is,
"Does the self disclosure serve the clients therapeutic goal?"
Giving or receiving significant gifts:
Giving or receiving gifts of more than token value is contrary to professional standards because
of the risk of changing the therapeutic relationship. For example, a client who receives a gift
from a member could feel pressured to reciprocate to avoid receiving inferior care. Conversely, a
member who accepts a significant gift from a client risks altering the therapeutic relationship and
could feel pressured to reciprocate by offering "special" care.
Dual and overlapping relationships:
Dual relationships should be avoided. These occur in situations where the member is both the
clinician and also holds a different significant authority or emotional relationship with the same
person. Examples can include course instructor, work place supervisor, or family member.
Members needs to remain cognizant that the purpose of avoiding dual relationships is to avoid
exploiting the inherent power imbalance in the therapeutic relationship. Overlapping
relationships, while potentially problematic, may not always be possible to avoid. Overlapping
relationships, where a member has contact, but no significant authority or emotional relationship

with the client, may occur particularly for therapists who are members of small communities, or
for clinicians who work with a particular client population with which they are also affiliated.
Such overlapping relationships can occur in situations where, for example; the client is a member
of a particular religious or ethnic group and tends to practice within this community or, the
member has a child with a learning disability, is active in a local association, and also does
learning disability assessments. Situations where there may be overlapping relationships need to
be judged on a case by case basis.
Members should avoid relationships with their clients outside of therapy where either the
therapist or client is in a position to give a special favor, or to hold any type of power over the
other. For example, some situations to be avoided include employing a client or his or her close
relatives, involving oneself in business ventures where one could benefit financially from a
clients expertise or information, or engaging in therapy or assessment with a current student.
Similarly, members should refrain from requesting favours from clients, such as baby-sitting,
typing, or any other type of assistance that involves a relationship outside therapy.
Types of Dual Relationships:

A social dual relationship is where therapist and client are also friends or have some
other type of social relationship. Social multiple relationships can be in person or online.
Having a client as a Facebook 'friend' on a personal, rather than strictly professional
basis, may also constitute social dual relationships. Other types of therapist-client online
relationships on social networking sites may also constitute social dual or multiple
relationships.

A professional dual relationship or multiple relationship is where psychotherapist or


counselor and client are also professional colleagues in colleges, training institutions,
presenters in professional conferences, co-authoring a book, or other situations that create
professional multiple relationships.

A special treatment-professional dual relationship may take place if a professional is, in


addition to psychotherapy and counseling, also providing additional medical services,
such as progressive muscle relaxation, nutrition or dietary consultation, Reiki, etc.

A business dual relationship is where therapist and client are also business partners or
have an employer-employee relationship.

Communal dual relationships are where therapist and client live in the same small
community, belong to the same church or synagogue and where the therapist shops in a
store that is owned by the client or where the client works. Communal multiple
relationships are common in small communities when clients know each other within the
community.

Institutional dual relationships take place in the military, prisons, some police
department settings and mental hospitals where dual relationships are an inherent part of
the institutional settings. Some institutions, such as state hospitals or detention facilities,
mandate that clinicians serve simultaneously or sequentially as therapists and evaluators.

Forensic dual relationships involve clinicians who serve as treating therapists, evaluators
and witnesses in trials or hearings. Serving as a treating psychotherapist or counselor as

well as an expert witness, rather than fact witness, is considered a very complicated and
often ill-advised dual relationship.

Supervisory relationships inherently involve multiple roles, loyalties, responsibilities and


functions. A supervisor has professional relationships and duty not only to the supervisee,
but also to the supervisee's clients, as well as to the profession and the public.

A sexual dual relationship is where therapist and client are also involved in a sexual
relationship. Sexual dual relationships with current clients are always unethical and often
illegal.

Some consider digital, online or internet dual relationships that take place online on
social networking sites, such as Facebook or Twitter, or on blogs, chats, or LinkedIn,
constitute unique dual or multiple relationships. These can be professional (i.e., on
LinkedIn or Facebook pages), social (i.e., Facebook or other social networking sites) or
other types of multiple relationships that take place on chats, Twitter, blogs, etc.

An additional and rather rare form of dual relationship includes adoption, when a
therapist legally adopts a former child client who was put up for adoption. Multiple
relationships also occur when a client refers a friend, family member or colleague to
therapy with the same therapist that he/she works with.

Dual Relationships Can Be Avoidable, Unavoidable Or Mandated

Voluntary-avoidable: Usually these dual relationships take place in large cities or


metropolitan areas where there are many therapists, many places to shop, worship or
recreate.

Unavoidable: These dual relationships are often found in isolated rural areas, small
minority groups, disabled groups or spiritual communities, on the Native American
reservations, or any small community in big metropolitan areas and training institutions.
They are also often unavoidable in sports psychology and spiritual counseling.
Supervisory relationships inherently involve multiple relationships as part of the triangle
of supervisor-supervisee-client.

Mandated: These dual relationships often take place in the military, prisons, jails and in
some police department settings.

Unexpected: Unexpected multiple relationships occur when a therapist is not initially


aware that the client they have been working with is also a friend, colleague, co-worker
or even an ex-spouse of another client. Similarly, unexpected dual relationships take
place when, unbeknownst to the psychotherapist, the client joins the therapist's church,
book club, or baseball recreation league.

Dual Relationships Can Be Concurrent Or Sequential

A concurrent dual relationship takes place at the same time as therapy.

A sequential dual relationship takes place after therapy has ended. For example, after
therapy ends a therapist decides to embark on social or business relationships.

Level of Involvement

Low-minimal level: When a therapist runs into a client in the local market or in the
theatre parking lot.

Medium level: When a client and therapist share occasional encounters, as in attending
church services every Sunday or occasional PTA meeting.

Intense level: When therapist and client socialize, work, attend functions or serve on
committees together on a regular basis.

Becoming friends:
Generally, members should avoid becoming friends with clients and should refrain from
socializing with them. Although there are no explicit guidelines that prohibit friendships from
developing once therapy has terminated, members must use their clinical judgment in assessing
the appropriateness of this for the individual client. Potential power imbalances may continue to
exist and influence the client well past the termination of the formal therapeutic relationship.
In the course of therapy, some clinicians, on occasion, may engage in activities that resemble
friendship, such as going on an outing with a child or adolescent, or attending a clients play,
wedding, or special event. In all cases it is the clinicians responsibility to ensure that the
relationship remains therapeutic and does not develop into a friendship or a romantic
involvement. The definition of "sexual abuse" within the legislation makes it clear that it is
unacceptable to date a current client. Since power imbalances may continue to influence the
client well past termination, professional standards prohibit a member from engaging in a sexual

relationship with a former client to whom any professional service was provided in the past two
years. Members are reminded that even the most casual dating relationship may lead to forms of
affectionate behavior that could fall within the definition of sexual abuse.
Maintaining established conventions:
Ignoring established conventions that help to maintain a necessary professional distance
between clients and members can lead to boundary violations. Examples include providing
treatment in social rather than professional settings, not charging for services rendered, not
maintaining clear boundaries between living and professional space in home offices, or
scheduling appointments outside of regular hours or when no one else is in the office.
Physical contact:
There are a variety of ways of using touch to communicate nurturing, understanding and support
such as a pat on the back or shoulder, a hug or a handshake. Such touch can however, also be
interpreted as sexual or inappropriate which necessitates careful and sound clinical judgment
when using touch for supportive or therapeutic reasons. Clinicians must be cautious and
respectful when any physical contact is involved, recognizing the diversity of cultural norms
with respect to touching, and cognizant that such behaviour may be misinterpreted.
Diagnostic and therapeutic work with children requires special consideration. Some agencies or
institutions for example, advise their staff to avoid any touching of children. In other settings
however, touching may be permitted, and this would ordinarily be open to public scrutiny. In
working with children and considering the question of touching, one might ask, "Would I do this

in the presence of my colleagues or this childs parents?" Again, good clinical judgment should
prevail for the protection of both the client and the practitioner.
Some clinical situations such as neuropsychological testing and biofeedback, or clinical
interventions such as bioenergetics, require touching the client. When such touch is necessary, it
is important to explain this to the client and ensure the clients understanding, and the clients
fully informed consent. If there is concern that a particular client may misinterpret a therapists
actions, members may wish to have someone else present in the session, consider an alternate
treatment approach, or think about a referral to another practitioner.
Questions to Consider in Examining Potential Boundary Issues
In each individual case, boundary issues may pose dilemmas for the clinician and there may be
no clear or obvious answer. In determining how to proceed, consideration of the following
questions may be helpful.

Is this in my clients best interest?


Whose needs are being served?
Will this have an impact on the service I am delivering?
Should I make a note of my concerns or consult with a colleague?
How would this be viewed by the clients family or significant other?
How would I feel telling a colleague about this?
Am I treating this client differently (e.g., appointment length, time of appointments,

extent of personal disclosures)?


Does this client mean something special to me?
Am I taking advantage of the client?
Does this action benefit me rather than the client?
Am I comfortable in documenting this decision/behaviour in the client file?

Does this contravene the Regulated Health Professions Act, the Standards of Professional
Conduct or the Code of Ethics, etc.?

BOUNDARY CROSSINGS AND BOUNDARY VIOLATIONS IN COUNSELLING

Boundary violations and boundary crossings in counseling and psychotherapy


refer to any deviation from traditional, strict, 'only in the office,' emotionally
distant forms of therapy. They mostly refer to issues of self disclosure, length and
place of sessions, physical touch, activities outside the office, gift exchange,

social and other non-therapeutic contact and various forms of dual relationships.
Boundary violations in therapy are very different from boundary crossings. While
boundary violations by counsellors are harmful to their patients, boundary

crossings are not and can prove to be extremely helpful.


Harmful boundary violations occur typically when counsellors and patients are
engaged in exploitative dual relationships, such as sexual contacts with current

clients. Exploitative business relationships also constitute boundary violations.


Boundary crossings can be an integral part of well formulated treatment plans or
evidence-based treatment plans. Examples are, flying in an airplane with a patient
who suffers from a fear of flying, having lunch with an anorexic patient, making a
home visit to a bed ridden elderly patient, going for a vigorous walk with a
depressed patient, or accompanying a patient to a dreaded but medically essential

doctor's appointment to which he or she would not go on their own.


Potentially helpful boundary crossings also include going on a hike, giving a nonsexual hug, sending cards, exchanging appropriate (not too expensive) gifts,

lending a book, attending a wedding, confirmation, funeral, or going to see a

client performing in a show.


Boundary crossings are not unethical. Ethics code of all major psychotherapy
professional associations (e.g., APA, ApA, NASW, ACA, NBCC) do not prohibit

boundary crossings, only boundary violations.


Like dual relationships, boundary crossings are normal, unavoidable and expected
in small communities such as rural, military, universities and interdependent

communities such as the deaf, ethnic etc.


Different cultures have different expectations, customs and values and therefore
judge the appropriateness of boundary crossings differently. More communally
oriented cultures, such as the Latino, African American or Native Americans, are
more likely to expect boundary crossings, and frown upon the rigid

implementation of boundaries in therapy.


Not all boundary crossings constitute dual relationships. Making a home visit,
going on a hike, or attending a wedding with a client and many other 'out-ofoffice' experiences are boundary crossings which do not necessary constitute dual
relationships. Similarly, exchanging gifts, hugging, or sharing a meal are also
boundary crossings but not dual relationships. However, all dual relationships,
including attending the same church, bartering, playing in the same recreational

league, constitute boundary crossings.


There is a prevalent erroneous and unfounded belief about the 'slippery slope' that
claims that minor boundary crossings inevitably lead to boundary violations and
sexual relationships. This somewhat paranoid approach is based on the 'snow ball'
effect. It predicts that the giving of a simple gift likely ends up in a business
relationship. A therapist's self disclosure becomes an intricate social relationship.
A non-sexual hug turns into a sexual relationship.

Boundary crossings with certain clients, such as those with borderline personality
disorder, must be approached with caution. Effective therapy with some clients

may require a clearly structured and well-defined therapeutic environment.


As with dual relationships, boundary crossings should be implemented according
to the client's unique needs and the specific situation. It is recommended that the
rationale for boundary crossings be clearly articulated and, when appropriate,

included in the treatment plan.


The meaning of boundaries and their appropriate application can only be
understood and assessed within the context of therapy. The context of therapy
consists of four main components: clients, setting, therapy and therapists.
Client factors include: Culture, history -- including history of trauma, sexual
and/or physical abuse -- age, gender, presenting problem, mental state and type
and severity of mental disturbances, socio-economic class, personality type and/or
personality disorder, sexual orientation, social support, religious and/or spiritual
beliefs and practices, physical health, prior experience with therapy and
therapists, etc.
Setting factors include: Outpatient vs. inpatient; Solo practice vs. group practice;
Office in medical building vs. private setting vs. home office; Free-standing clinic
vs. hospital based clinic; Privately owned clinic vs. publicly run agency; The
presence or proximity of a receptionist, staff or other professionals. It also
includes Locality: Large, metropolitan area vs. small, rural town vs. Indian
reservation; Affluent, suburban setting vs. poor neighborhood vs. university

counseling center; Major urban setting vs. remote military base, prison or police
department setting.
Therapy factors include:

Therapeutic factors, such as modality: Individual vs. couple vs. family


vs. group therapy; Short term vs. long term vs. intermittent long-term
therapy; Intensity: Therapy sessions several times a week vs. once a month
consultation; Population: Child vs. adolescent vs. adult psychotherapy;
Theoretical Orientation: Psychoanalysis vs. humanistic vs. group therapy

vs. body psychotherapy vs. eclectic therapy.


Therapeutic relationship factors: Quality and nature of therapeutic
alliance, i.e., secure, trusting, tentative, fearful or safe connection. Intense
and involved vs. neutral or casual relationships; Length, i.e., new vs. longterm relationship; Period, i.e., beginning of therapy vs. middle of therapy
vs. towards termination; Idealized/transferencial relationships vs. familiar
and more egalitarian relationships; Familiarity and interactivity in the
community vs. only in the office, distanced relationship; Presence or
absence of dual relationships and type of dual relationships, if applicable.
Therapist factors include: Culture, age, gender, sexual orientation; Scope
of practice (i.e., training and experience).

REFERENCES

www.yoursocialworker.com/boundaries.htm
www.zurinstitute.com/dualrelationships.html
www.goodtherapy.org/blog/50-signs-good-therapy
www.ncbi.nlm.nih.gov