One of the most difficult components of this position is having to release a clinician, but in the case of Tom Martin, I feel as if I have no choice. Tom has been with us four years and has received several complaints, one in which he partially substantiates. He admits attraction to the client. It is not known at this point whether she will file a formal complaint, but if I do nothing to resolve the issue, it will reflect on our agency, especially if she pursues legal recourse or makes a complaint with an organization or licensing board.
I have planned a meeting with Tom in which I will confront him with these issues and have a mediation process. We will then begin focusing on the issues, interpreting their meanings and directing an appropriate course of action. The issue is whether Tom has been ethical in his practice. After confronting Tom, he will need to admit his short-comings as a therapist. It is fairly evident that he has taken advantage of the situation. It is quite suspect that he has lost female clients.
Studies have shown that unethical practices cause clients to discontinue service and ruin their ability to have a trusting client-clinician relationship (Pope). We have to explore client-clinician boundaries, of which I am sure Mr. Martin is well aware of. It is definitely unethical to take advantage of his position; it is abuse of power. Mr. Martin admits that he is attracted to the client. This makes her interpretation of the situation more plausible. I am a bit alarmed that he has chosen to keep her as a client instead of referring her to someone who is more able to help her resolve her issues.
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Research has proven that an unbalanced relationship hinders the client from her original goal (Pope). After presenting Tom with the evidence, we will begin the process of releasing him. After initiating the ending, we will explore his thoughts and feelings about what inevitably has to take place and why. We will go over how our expectations of him were expressed in the beginning of his employment. We will also speak of how much he has accomplished since he has joined our team and how it has changed over time. We will then speak on the course of action that should be taken.
If this were the first incident, I would recommend probation, but the occurrences have become more frequent, so I plan to terminate the relationship. Not only have they become more frequent, but more apparent. It is difficult to note if he will be more flagrant. I will tell him of how a new setting will give him time to readjust and reevaluate his situation and recommend counseling to enable him to discover why he is being exploitative in his sessions with female clients. My next meeting will be with Janice Wellington.
She has been with our agency for two years and is doing very well. We will summarize her accomplishments and I will reiterate her performance. It will not be hard to encourage her to continue to do a great job. I just need to help her believe it. At this point, I need to just reinforce what she is doing and probably monitor her performance myself weekly. I will share some of my logs with her and show her how to complete them. I am not much concerned with her desire to work with children over adults but this is an issue that will be addressed.
We will go over her progress thus far and point out her track record. We will also explore her boundary issues as far as to why there is a greater boundary between the adults she counsels than with the children she counsels. We will have to see if this will become a potential problem in the future and if she will be fit to do child psychology than family therapy and what issues are creating these dynamics. Is it age, gender? We have to assess this behavior and take the necessary steps to change it so she will not become emotionally distant from her present clients.
We will begin to set goals about helping her to become more comfortable with adults. Perhaps she needs a mentor to evaluate some of her counseling sessions and talk about where she feels uncomfortable. She will need to improve her organizational skills and build her confidence. After we explore how she feels and what makes counseling children preferable to adults, we can begin to address the issue and hopefully resolve it so that Janice can be the counselor in her mind that she is on paper. Lastly we have Michael Thompson, a former addict who presents today with several issues.
He is financially and mentally stressed, missing work and uncertain of his ability to perform at his best. Mr. Thompson will have to be questioned. After questioning him, we will reflect on his feelings and the meaning of his situation. If he feels he needs additional help I will refer him to our employee assistance program. I will continue to support him, as there have been no complaints from his clients. However, for the next month, I will take over his caseload and we will assess the findings as a team.
In the mean time, he will get counseling and we will revisit the situation in a month. I do not wish to terminate him at this point since there is no evidence that he is doing drugs. He has been with the agency for 16 years and recovered from addiction for 18 years. According to the code of ethics, a therapist should refrain from practice when there is physical or psychological conditions as a result, for example alcohol, drugs or personal stress in such abilities or professional judgment are seriously impaired (Tjeltveit).
Since there is no evidence of this, we will talk about potential boundary issues, as none have been crossed yet. Boundary issues occur when practitioners face potential conflicts of interest stemming from what have become known as dual or multiple relationships. A professional enters into a dual relationship whenever he or she assumes a second role with a client, becoming social worker and friend, employer, teacher, business associate, family member, or sex partner.
A boundary violation occurs when a practitioner engages in a dual relationship with a client or colleague that is exploitative, manipulative, deceptive, or coercive (Reamer). Although Mr. Thompson has not appeared to have done any of these things, one key feature of boundary violations is a conflict of interest that harms clients or colleagues. Conflicts of interest occur when professionals find themselves in a relationship that could prejudice or give the appearance of prejudicing their decision making.
In more legalistic language, conflicts of interest occur when professionals are in “a situation in which regard for one duty leads to disregard of another or might reasonably be expected to do so (Reamer). In this regard, Mr. Thompson may have a boundary issue, only because it is said that he has stated not being able to relate to his clients’ addiction issues as well as he has been able to in the past. We will have to sit down and discuss the reasoning behind this. His abject or apathetic approach to therapy may begin to interfere with his ability to function in the best interest of the client.
We must set a goal to get him back on the right track and evaluate him to see if he wants any counseling to address his current situation. This may be regression under stress (text) and we will have to discuss it more openly. We will definitely need to discuss where we were when we began. We will look back over the past 16 years of service and see what he got accomplished and how he got through the tough times successfully. He can reflect on past issues and feelings of inadequacy and think about how he got through such times. This will help put him on the path to recovery.
We will definitely need to address where he feels he is headed as it will be very instrumental in which path will best be suited to get him back on the right track.
Reamer, Frederic G, Tangled Relationships: Managing Boundary Issues in Human Services, NY, Columbia University Press, 2001. Tjeltveit, Alan C, Ethics and Values in Psychotherapy, London and New York, Routledge, 1999. Pope, Kenneth S and Jacqueline C Bouhoutsos, Sexual Intimacy Between Therapists and Patients, New York, Westport, CT and London, Praeger Publishers, 1986.
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