Welcome To The 2017 Spring ICB Conference

1. Welcome To The 2017Spring ICB Conference

2. Providing DUI and Behavioral Health Services Patricia R. Diel MSW, LSW, CADC, SAP ~Diel Counseling ~ 444 S. Willow 903 W. Lincoln Ave Effingham, IL 62401 Charleston, IL 61920 217-347-7384 patricia@dielcounseling.com

3. George K. Rafeedie MPA, CSADC CONSULTATION ASSESSMENT & TREATMENT SERVICES GKR410@GMAIL.COM

4. Catch 22Dual Relationships - Ethical Concerns In Small Communities and Closed Settings

5. Training Room Agreements • Only One Person Speaking At A Time • Be Respectful And Professional • No Side Sidebars • Stay On Point • Enjoy Academic Freedom • Free To Ask Anything • Don’t Talk About Others • Participate In Exercises • Have Fun

6. DUAL RELATIONSHIPS

7. DUAL RELATIONSHIPS OVERVIEW • Define The Issues • Evaluate Potential Conflicts • Discuss Boundary Issues Counselors / Supervisors Face When They Live And Work In Small Rural Communities • Military Settings • Residential Treatment • DOC (Prison, Parole, Probation)

8. DUAL RELATIONSHIPS OVERVIEW • Explore The Special Challenges That Are Presented By The Powerful Influences Of Social Media • Setting Boundaries & Crossings Vs Violations • Discuss Whether Dual Relationships Are Ever Acceptable • Review Various Codes of Ethics

9. DUAL RELATIONSHIPS WORKSHOP GOALS • Evaluate Your Roles & Responsibilities To Provide Ethical Boundary Setting In The Real World: • Clinician • Clinical Supervisor • Colleague • Ethical Responsibilities • Improve Your Ability To Deal With Boundary Issues & Ethical Dilemmas • Develop Your Action Plan

10. DUAL RELATIONSHIPS WORKSHOP GOALS • Participants will be able to apply critical thinking related to setting and maintaining boundaries • Participants will be able to clearly define dual relationships • Learn to appropriately evaluate if a dual relationship is harmful to the client or counselor/client relationship • Through practice will be able to demonstrate the application of the code of ethics in various settings

11. DUAL RELATIONSHIPSSCENARIO CITY • Scenario 1 --- Family Reunion • Scenario 2 --- Walmart • Scenario 3 --- My House • Scenario 4 --- Daughter • Scenario 5 --- The Car

13. DEFINE THE ISSUES • In every setting and in every area in this line of work, we encounter boundary issues such as whether to engage in a friendship with a former client, accept gifts or invitations from clients, hire former client who has expertise, disclose personal type information and various kinds of sharing of information. • In rural or small towns, communities, the possibility of simultaneous personal and professional involvement is high if not inevitable.

14. DEFINE THE ISSUES • Ethical issues related to professional boundaries are common and complex • Dual relationships in small communities and rural areas take several forms, most common overlapping social relationships and overlapping business or professional relationships

15. Complex Boundaries • Ethical issues surrounding boundaries and dual relationships, particularly in small and rural communities are much more complex than they may first appear. • What constitutes sound ethical practice in urban areas may not completely parallel the practice of their rural and small community counterparts. Catch 22 …Small community workers are not just rural practitioners. They are also professionals who live and work in these small communities.

16. SMALL RURAL COMMUNITIES In small communities, rural communities, some unanticipated encounters between workers and clients are innocuous and unlikely to pose significant problems. For example practitioners who encounter each other in a local supermarket, pharmacy may feel awkward but these brief unplanned encounters are not likely to have significant lasting repercussions.

17. Accidental Crossings • Accidental crossings, particularly in small communities are not inherently unethical but require skill in handling • ________ __________ ???

18. Setting Boundaries • Practitioners and, practitioners and clients can come up with relatively straightforward ways to manage boundary issues • Some clients we have to assist in maintaining boundaries

19. Boundary Crossings and Boundary Violations Generally Refer to any deviation from traditional, strict “only in the office’ emotionally distant forms of therapy or any deviation from rigid risk-management protocols

20. DEFINING BOUNDARIES • Boundary Violations - occur when therapist (workers) cross the line of decency and violate or exploit their clients • Boundary Crossing - often involves clinically interventions, such as self-disclosure, home visit, non-sexual touch, gifts or bartering

21. GREY BOUNDARIES • There are the “grey areas” around professional boundaries that require the use of good judgement and careful consideration of the context---for instance: • _______ a client • Terms of endearment • _______

22. WARNING SIGNS FORBOUNDARY CROSSINGS Examples of ‘YELLOW LIGHTS’: • Time spent with a patient beyond what is needed to meet the therapeutic needs; • Choosing patients based on factors such as looks, age, or social standing; • Responding to personal overtures by the patient; • Sharing personal problems with a patient; • Dressing differently when seeing a particular patient; • Frequently thinking about a patient outside of the context of the therapeutic relationship; • Being defensive or making excuses when someone comments on or questions your interactions with a patient;

23. WARNING SIGNS FORBOUNDARY CROSSINGS • Being hesitant (except for reasons of confidentiality) or embarrassed to discuss the relationship between you and your patient; • Providing the patient with a home phone number or email address unless it is required in the context of a therapeutic relationship; and • Maintaining a patient on treatment longer than required.

24. DIGITAL RELATIONSHIPS

25. DIGITAL BOUNDARIES • Complex and evolving • ______ clients, your therapy profile, etc. •  Implications professionally? • Socializing with clients in general??

26. DIGITAL BOUNDARIES • Can social media effect/affect the therapeutic relationship?? • Should clients and workers be friends on FACEBOOK?

27. DUAL RELATIONSHIPS AND BOUNDARIES • Dual relationships or multiple relationships refers to any situation where multiple roles exist between a therapist and a client • While each separate situation may appear harmless, when put together may form a pattern of boundary crossing

28. TWO SIDES • Those who support avoiding dual relationships at all costs • Those who say these relationships are situational and contextually determined • Will this dual relationship in any way inhibit the clients actions and choices in other areas of their life and if there are ways in which the client will feel that he or she cannot disagree with the therapist because of outside demands of any sort.

29. TWO SIDES • Some research has even indicated that dual relationships are not necessarily problematic if the clients welfare is not compromised. • Situations can even become opportunities for effective role modeling by professional counselors in small and rural communities. • Mandated dual relationships…prison, military???

30. TWO SIDES • The relative isolation of the area itself, limited resources and options, distinct community and cultural norms all contribute to the high possibility of secondary relationships. • So dual relationships in small and rural communities are almost an inevitable part of everyday practice.

31. TWO SIDES • Dual relationships in small communities and rural areas take several forms, most common overlapping social relationships and overlapping business or professional relationships • Client who is employed at the same company as the practitioners spouse and there is a holiday party for the company --- • may not be able to avoid encountering the client…

32. Types of Dual Relationships • Social (in person, Facebook) • __________ • Treatment –Professional • Business • Communal • Institutional • Forensic • ____________ • Sexual • Online, Internet • Additional • _____________

33. Concurrent & Consecutive Dual Roles • Concurrent - exists when a therapist has two roles at the same time with the same client or with a person who is in a significant relationship with the client • Consecutive - exists when dual roles involve a prior relationship that involves either a professional or nonprofessional role followed by the development of a second relationship at a later point in time

34. SETTING THE BOUNDARY • Given the likelihood that such dual relationships will occur, workers should anticipate the ways in which their professional lives may intersect with their personal lives and family lives • Where appropriate talk with clients about how they might best handle these challenging circumstances

36. WHO HAS BOUNDARY ISSUES ?

37. IAODAPACA Code of Ethics 2.04.02 Certified AODA Professionals shall not enter into a counseling relationship with members of their own family, close friends, persons closely connected to them, or others whose welfare might be jeopardized by such a dual relationship 2.02.09 Certified AODA Professionals shall not engage in any sexual relationship, conduct, contact, exploitation, or harassment with clients, former clients, client’s partners, clients relatives, or any active client of any Office as defined in section 2.16 of the code of procedure. This prohibition is in effect during the time of any active counseling relationship and in perpetuity once the counseling relationship has ended. 2.02.10 Certified AODA Professionals shall not engage in any sexual relationship, conduct, contact, exploitation or harassment with students or supervisees.

39. American Association for Marriage and Family Therapy • 1.3 Multiple Relationships.  Marriage and family therapists are aware of their influential positions with respect to clients, and they avoid exploiting the trust and dependency of such persons. Therapists, therefore, make every effort to avoid conditions and multiple relationships with clients that could impair professional judgment or increase the risk of exploitation. Such relationships include, but are not limited to, business or close personal relationships with a client or the client’s immediate family. When the risk of impairment or exploitation exists due to conditions or multiple roles, therapists document the appropriate precautions taken. 

40. American Association for Marriage and Family Therapy • 1.4 Sexual Intimacy with Current Clients and Others. Sexual intimacy with current clients or with known members of the client’s family system is prohibited.  • 1.5 Sexual Intimacy with Former Clients and Others. Sexual intimacy with former clients or with known members of the client’s family system is prohibited.

42. NASW Code of Ethics • Social workers should be alert to and avoid conflicts of interest that interfere with the exercise of professional discretion and impartial judgment. Social workers should inform clients when a real or potential conflict of interest arises and take reasonable steps to resolve the issue in a manner that makes the clients’ interests primary and protects clients’ interests to the greatest extent possible. In some cases, protecting clients’ interests may require termination of the professional relationship with proper referral of the client. • Social workers should not take unfair advantage of any professional relationship or exploit others to further their personal, religious, political, or business interests.

43. NASW Code of Ethics Standard 1.06 • Social workers should not engage in dual or multiple relationships with clients in which there is a risk of exploitation or potential harm to a client. In instances when dual or multiple relationships are unavoidable, social workers should take steps to protect clients and are responsible for setting clear appropriate and culturally sensitive boundaries. • (Dual relationships occur when social workers relate to clients in more than one relationship, whether professional, social or business. Dual relationships can occur simultaneously or consecutively.

44. NASW Continued 1.09 Sexual Relationships • Social workers should under no circumstances engage in sexual activities or sexual contact with current clients, whether such contact is consensual or forced. • Social workers should not engage in sexual activities or sexual contact with former clients because of the potential for harm to the client. If social workers engage in conduct contrary to this prohibition or claim that an exception to this prohibition is warranted because of extraordinary circumstances, it is social workers—not their clients—who assume the full burden of demonstrating that the former client has not been exploited, coerced, or manipulated, intentionally or unintentionally.

46. Challenging The Codes In rural and small practice, personal and professional roles can easily become unintentionally blurred. In these settings, prevailing standards and codes of ethics cannot be applied in automatic ways.

47. Dual Relationships • You’ve been treating a patient on and off for several years and have gotten to know each other quite well. • Your relationship is at the point that it feels more like you are reconnecting with an old friend. • This is a good thing… right? _________

48. Dual Relationships • In order to answer this question you need to know how a personal relationship and a professional relationship differ from each other. • Without knowing the differences between the boundaries of a personal and professional relationship, how will you know if the line between the two is blurred or even crossed?

49. Dual Relationships Professional boundaries are intended to set limits and clearly define a safe therapy situation between therapist and client. Like a dual relationship that is sexual, a nonprofessional dual relationship has the potential to blur boundaries between counselor and client, create a conflict of interest, enhance the potential for exploitation and abuse of power and/or cause the counselor and client to have different expectations of therapy.

50. Dual Relationships • So….Nonsexual dual relationships are not prohibited (some are ill advised) however navigating dual relationships can be challenging. • Counselors/practitioners are ethically mandated to approach dual relationships with care and caution. Informed consent can be a critical component of engaging in a dual relationship (non-sexual). • And this included specifying the potential negative consequences of such a relationship. • Do what is in the best interest of the client.