Monday, June 3, 2019
Boundary Issues in Therapy: Case Study
Boundary Issues in Therapy Case StudyCritically analyse the secondions of the therapist from the perspective of the BACP and BABCP codes of employ and from the perspective of line issues.The initial assessment of S revealed the presence of depressive symptoms, alcoholic drink and substance use and poor coping skills, characterised by a chaotic household routine and toughies managing her cardinal children. Although limited information is available regarding the development of Ss current problems, it would appear that predisposing factors may include a history of physical abuse in her own family and pre-existing low mood and irritability. During the assessment, S described a vicious cycle of depressive feelings, negative automatic thoughts and avoidance behaviours, which appear to pick out maintained and exacerbated her current state. In addition to the disordered domestic situation previously mentioned, S depicted her relationship with her two young children as macrocosm somet hing of a struggle, as she found their fighting with each other problematic and she state that she sometimes loses control and slaps them hard on their legs and hands. Furthermore, S stated that she leaves her 11 course of study old child daughter to look after her 5 year old daughter. Whilst professing her wish for help, S also adjudge her fear of losing her children.The counsellor articulated their wish to help S with her depression. In doing so, the counsellor is complying with fundamental rules of both BABCP and BACP guidelines, in terms of aiming to resolve problems and promote well-being (BABCP, 2007) and adhering to the beneficence principle (BACP, 2007). However, the counsellor did not, at this stage, expand upon any accomplishable interventions which may be employed for Ss depression, nor did they explicate a visualise to manage Ss alcohol and substance use. At this stage of therapy, it would be useful to begin the process of establishing a healing(p) alliance (Deri sley and Reynolds, 2000), in terms of introducing mutually agreed goals and a shared formulation (Kirk, 1989). Such an alliance has been demonstrated to be positively associated with treatment participation and outcomes amongst alcoholics (Connors, DiClemente et al., 1997). Furthermore, this is congruent with the BACP principle of autonomy, i.e. the importance of the clients commitment to participating in counseling or psychotherapy and with the BABCPs guideline of discussing and agreeing the aims and goals of interventions from the outset of therapy.The quality of empathy, an assign described in BACP guidelines as one which counsellors and therapists should aspire to is not manifestly portrayed in the case study. An empathic therapist style has been associated with low levels of client resistance and with greater long-term metamorphose amongst individuals with addictive behaviours (Miller, Sovereign and Krege, 1989 cited in Miller and Rollnick, 1991). Accurate empathy has also b een described as facilitating further disclosure of feelings and cognitions and thus, therapeutic collaboration (Marshall, 1996).Confidentiality within a therapeutic relationship is acknowledged as a crucial and implicit feature within BACP codes of practice. This is reflected in the principle of fidelity, i.e. honouring the trust placed in a practitioner confidentiality is an obligation .. any disclosure is restricted to furthering the purposes for which it was disclosed (BACP, 2007). The BABCP also lists confidentiality within its guidelines for good practice, just is slenderly less robust in its communication of this, stating that information acquired by a worker is confidential within their understanding of the best interest of the service drug user and the law of the land (BABCP, 2007). The counsellor working with S made the decision to break confidentiality due to their concerns about the welfare of Ss children and informs S that she go away be requesting a social servic es assessment of the home situation. In view of Ss previous expression of her fear of losing her children, this information is passing likely to reinforce her anxieties and potentially seeks alienating her from the therapeutic alliance and disengaging from any intervention. However, the clear dilemma facing the counsellor was acting upon the perceived risk to Ss children, whilst maintaining confidentiality and trust. Both BACP and BABCP codes of practice affirm that confidentiality must be within jural constraints. When elucidating the principle of justice, the BACP refers to remaining alert to potential conflicts between legal and ethical obligations and further to be aware of and understand legal requirements and be legally accountable.With regard to legal aspects of Ss case, the childrens act of 2004 continues to allow smacking as long as it does not cause visible marks. It is not clear whether Ss smacking of her daughters constitutes illegal activity, just of more concern is her admission that she loses control when slapping them. Also of concern is the information that S allows her 11 year old daughter to care for her 5 year old when she herself feels unable to cope. Whilst S does not actually leave the children alone in the house and therefore is not breaking the law, the emotional squeeze upon her children would be a potential issue requiring attention. Returning to the actions of the counsellor in this circumstance, it would be highly beneficial to obtain more information about the nature of Ss relationship with her daughters, including the frequency of her smacking them and a clearer impression of their routine, in order to establish the possibility of neglect. The BABCP code of practice states that the therapist should minimize possible harm and maximize benefits whilst balancing these against any possible harmful effects to others (BABCP, 2007) and this is echoed by the BACP, which draws attention to situations in which clients pose a risk of c ausing sound harm to themselves or others the therapist should be alert to the possibility of conflicting responsibilities between those of their client, others and society (BACP, 2007). Whilst the decision faced by the counsellor was a difficult one, a possible course of action would have been to declare the potential need to break confidentiality from the outset. wakeless practice guidelines typically incorporate an initial averment which refers to disclosures remaining confidential unless there is a risk of harm to the self or others (Jenkins, 1997 Bond, 2000) and apprising S of this possibility from the outset may have attenuated, to some extent, the impact of learning that a social services assessment would be requested.One alternative course of action for the counsellor in this situation would have been to prorogue a social services assessment until S had had an opportunity to implement the contract of behaviour regarding her children and the counsellor had sought supervis ion. There did not appear to be any urgency in Ss home situation, therefore it would seem reasonable to seek supervision prior to taking any spry action. Both BACP and BABCP codes strongly dictate seeking supervision if faced with a situation outside their competence (BABCP, 2007) and paying careful consideration to the limitations of their training and finger (BACP, 2007).In terms of informing the GP of Ss overall problem issues, but keeping the substance and alcohol abuse confidential, this would appear to be consistent with guidelines of keeping communication between colleagues purposeful (BACP, 2007) and relevant (BABCP, 2007). The counsellor mentions working on strategies to reduce Ss behaviours around substance and alcohol abuse and, as previously mentioned, further clarification of this intervention would have been helpful. cognitive therapy for substance abuse emphasises identifying and testing thoughts and images about using drugs, modifying beliefs that increase the risk of drug use, coping with drug cravings and providing relapse prevention (Beck et al., 1983 Marlett and Gordon, 1989). Illustrating this process with S may have ameliorated the formation of a working alliance, as well as providing her with greater information about the intervention process, thus increasing her self-determination and autonomy (BACP, 2007). Furthermore, as S appeared to be at the contemplation stage of want to change (Prochaska and DiClemente, 1982, cited in Miller and Rollnick, 1991), an informative approach may have consolidated this state and enabled S to further move around the wheel of change into a state of determination or action.With regard to boundary issues in the case study, a clear example of how this may be problematic in the counsellors relationship with S is in the area of a dual relationship (Schapp et al., 1996). That is, the emergence of conflicting responsibilities relating to S being the client but her childrens welfare being a clear cause for con cern contributed to a potentially disruptive, ambiguous boundary. In this case, the ethical dilemma was apparent and although the codes of practice referred to provide some guidance and principles for managing such difficulties, it has been noted that guidelines and standards inform rather than determine our ethical decisions (Gillon, 1986). As such, in dealing with a client with furbish up parental responsibility, this is the nature of the issues confronted by a counsellor.ReferencesBeck, A.T., Wright, F.D., Newman, C.F. and Liese, B.S., 1983. Cognitive Therapy of Substance Abuse. The Guildford Press.Bond, T., 2000. Standards and Ethics for Counselling in Action. London Sage.British Association of doingsal and Cognitive Psychotherapy, 2007. Guidelines for Good Practice of Behavioural and Cognitive Psychotherapy. acquirable from www.babcp.co.ukcited 30 April, 2008British Association of Counselling and Psychotherapy, 2007. Ethical Framework for Good Practice in Counselling and Psyc hotherapy.Available from http//www.counselling.co.ukcited 30 April, 2008Childrens Act, 2004. Chapter 31. London HMSO.Connors, G.J., Carroll, K.M., DiClemente, C.C., Longabaugh, R. and Donovan, D.M., 1997. The therapeutic alliance and its relationship to alcohol treatment participation and outcome. Journal of Counselling and Clinical Psychology, 65 (4), pp. 582-598.Derisley, J. and Reynolds, S., 2000. The transtheoretical stages of change as a predictor of premature termination, attendance and alliance in psychotherapy. British Journal of Clinical Psychology, 39, pp. 371-382.Gillon, R., 1986. Philosophical Medical Ethics. New York Wiley.Jenkins, P., 1997. Counselling, Psychotherapy and the Law. London Sage.Kirk, J., 1989. Cognitive Behavioural Assessment. In, Hawton, K., Salkovskis, P., Kirk, J. and Clark, D.M. (Eds), 1989, Cognitive Behaviour Therapy for Psychiatric Problems A Practical Guide. Oxford Oxford University Press.Marlett, G.A. and Gordon, J.R. (Eds), 1989. Relapse Prevent ion Maintenance Strategies in the Treatment of Addictive Behaviours. New York Guildford.Marshall, S., 1996. The Characteristics of Cognitive Behaviour Therapy. In, Marshall, S. and Turnbull, J., 1996. Cognitive Behaviour Therapy An Introduction to Theory and Practice. Balliere Tindall.Miller, W.R. and Rollnick, S., 1991. motivational Interviewing Preparing People to Change Addictive Behaviour. New York Guildford.Miller, W.R., Sovereign, R.G. and Krege, B., 1989. The Check-up A Model for Early Interventions in Addictive Behaviours, cited in, Miller, W.R. and Rollnick, S. (Eds.), 1991, Motivational Interviewing Preparing People to Change Addictive Behaviour. New York Guildford.Prochaska, J.O. and DiClemente, C.C., 1982. Transtheoretical therapy toward a more integrative model of change, cited in Miller, W.R. and Rollnick, S., 1991. Motivational Interviewing Preparing People to Change Addictive Behaviour. New York Guildford.