The number of homebound individuals in the United States is on the rise, causing health-care professionals to expand in-home health services to help meet the increased demand. Due to the prevalence of feelings of isolation and depression in this population, it is imperative that mental health professionals join this effort to increase access to mental health services. Delivering psychotherapy in clients’ homes presents many advantages to these homebound individuals, but there is a dearth of literature addressing how therapists should handle (...) unique ethical issues that arise in this type of setting. This article addresses ethical considerations and guidelines for in-home provision of mental health services. General ethical issues related to home-based psychotherapy include boundaries, confidentiality and privacy, competency, insurance coverage, and autonomy. Issues pertaining to different categories of homebound individuals, including persons with agoraphobia, chronic illnesses, and older adults, are then discussed in turn. Recommendations on how to best manage these issues by applying the American Psychological Association’s, the American Counseling Association’s, and the National Association of Social Workers’ Ethics Codes are provided. (shrink)

Modal responses to items from a recent survey of independent practitioners regarding the impact of managed care on their practices and ethics were presented to participants as the responses of a hypothetical independent practitioner. Participants were asked to consider seeing this hypothetical practitioner both before and after being informed of the practitioner's responses to the managed care survey. Results indicate that when participants were informed of the practitioner's views toward managed care, their own attitudes toward therapy changed significantly. Specifically, compared (...) to uninformed participants, informed participants were significantly more likely to believe that managed care would have a negative impact on treatment and significantly less likely to see an independent practitioner, use insurance benefits, expect to benefit from treatment, expect to form a strong working relationship, and trust that the practitioner would work in their best interest. Implications regarding ethics and informed consent are discussed. (shrink)

The British Columbian members of the Canadian Guidance and Counselling Association were surveyed to explore their attitudes regarding dual relationships. Of 529 deliverable surveys, 206 usable returns yielded a response rate of 39%. Participants were asked to provide incidents of problematic dual relationships and to discuss the problematic aspect(s) of these dual relationships. Respondents provided a total of 110 useable incidents with 165 associated problematic aspects. Many respondents provided data not directly related to the original questions, which were also analyzed. (...) The results of this study draw attention to several issues: (a) counselors are dealing with a variety of problematic dual relationships, (b) counselors experience discomfort and negative effects on their personal/work life secondary to these dual relationships, and (c) counselors consider the unique context of each dual relationship to be important in their ethical decision-making processes. (shrink)

Boundary crossings in academia are rarely addressed by university policy despite the risk of problematic or unethical faculty - student interactions. This study contributes to an understanding of undergraduate college student perceptions of appropriateness of faculty - student nonsexual interactions by investigating the influence of gender and ethnicity on student judgments of the appropriateness of numerous hypothetical interactions. Overall, students deemed the majority of interactions as inappropriate. Female students judged a number of interactions as more inappropriate than did male students, (...) and with a few exceptions, Mexican American and Anglo American students were similar in their ratings of the appropriateness of faculty - student interactions. These findings suggest that universities need to be proactive in establishing guidelines concerning faculty-student boundary crossings. (shrink)

This study examined how psychotherapists address hypothetical nonsexual multiple relationships dilemmas with Asian American clients and identified predictors of conservative decisions and the use of culture-based rationales. This survey of 787 Asian American and non-Asian American psychotherapists revealed that clinicians rely on mostly their personal policies and seldom focus on the clients' cultural backgrounds. Psychotherapists who consider their clients' Asian culture have more cultural knowledge and awareness, have been mental health providers longer, and are Asian American and female. Clinicians who (...) avoid multiple relationships tend to cite formal policies as justification and are less likely to consider clients' cultural worldviews, the therapeutic relationship, or their own values. The results are discussed in terms of specific revisions needed in the American Psychological Association Ethics Code, the benefits of more frequent consultation with colleagues and supervisors about ethical dilemmas, and recommendations for psychotherapists. (shrink)

There are many ethical issues arising for practitioners in what are termed the boundaries of professional helping relationships. In this article, the authors argue that the boundary metaphor is not sufficient for conceptualizing these ethical issues and propose that alternative metaphors be considered. The use of a different metaphor might allow practitioners to re-vision the relationship issues in a more realistic, richer, and holistic way. Those explored here include highway, bridge, and territory. For the authors, it is territory that seems (...) to hold the greatest promise. (shrink)

Based on individual and focus-group interviews, this article describes how social workers in a variety of settings and geographical areas within Ontario approached ethical issues in their daily practices. Two primary approaches to professional ethics emerge from the data: principle based and virtue based, reflecting the orientation of groups we label believers and skeptics, respectively. The code of ethics appears to be the fulcrum from which our participants swing. The believers show faith in the code of ethics and the skeptics (...) are dubious that codes are necessarily in the best interests of clients. The article describes the thinking behind the actions of the believers and skeptics and explores possibilities for future practice and research with respect to decision-making regarding ethical issues in the social work profession. (shrink)

This study describes social workers' attitudes and behaviors in relation to different types of nonsexual multiple role relationships, views about the National Association of Social Workers Code of Ethics section on nonsexual multiple role relationships, and formal education on multiple role relationships. A relatively high proportion of the sample of members of the NASW chapter in New York City rated each of 18 types of nonsexual multiple role relationships as ethical, particularly when qualified as "under some conditions." Many respondents had (...) engaged in nonsexual multiple role relationships with subordinates, although less often with current clients and students than with former clients, supervisees, and employees. Education on nonsexual multiple role relationships appears to be inadequate. Although most endorsed the NASW Code of Ethics section on multiple role relationships, a substantial proportion reported confusion about the interpretation of the wording. The adoption of operationally defined guidelines on multiple role relationships by agencies and the provision of safe and supportive environments that encourage open discussion and attention to this issue in supervision may help to minimize inappropriate behaviors. (shrink)