Individual case study research and analysis

Ethical Issues and Therapy

In the caring professions, codes of ethics are particularly important in terms of a focus on the relationship between professionals and clients. Centuries of development have culminated in an ethical code where boundaries are considered to be an important component of this relationship. Indeed, a therapist is expected to maintain an appropriate relationship with clients in terms of maintaining very specific physical boundaries. However, these boundaries can also become somewhat murky, especially where non-sexual contact is concerned. Most critics appear to suggest that the best approach is to maintain as much physical distance as possible between therapists and clients, especially in the light of unforeseen damage that can occur to both the client and the therapist, especially when a supposedly innocent gesture meant to comfort can be misunderstood or misconstrued.

One critic for the opposite position is Totton (2011), who appears to believe that too many boundary constraints result in what he refers to as "defensive practice." According to this author, adding legal jargon to boundary rules and conditions, as well as developing somewhat extreme regulations, has created a clinical environment that is no longer necessarily conducive to best practice. Instead, therapists are forced to move within the set boundaries while some clients may in fact require the occasional touch or hug for a sense of comfort. In other words, the author believes that too many boundary conditions have created a loss of basic spontaneity in the therapeutic process.

However, it is also true that creating a situation in which an occasional hug or touch could comfort the client could lead to inappropriate feelings in the therapist. Therapists should therefore be trained to respond appropriately to such feelings in order to prevent pitfalls that could lead to legal or professional repercussions.

The appropriateness of non-sexual physical contact such as hugging and touching in the therapeutic process has been much debated among critics and professionals within psychiatry and psychology, as Sarkar (2004) notes. She refers to the concept of "boundary" in professional practice as "the distinction between professional and personal identity." In other words, one of the ways in which the therapist can protect him- or herself against acting on inappropriate feelings, even if they do occur, is to be aware of and apply such boundaries.

This argument opposes the one forwarded by Totton (2011), but nevertheless appears to be sensible in the light of the "slippery slope" that could be created by excessive physical contact, despite the level of initial innocence. Indeed, Sarkar (2004) includes in her list of non-sexual potential boundary violations "touching or frequent hugs." While specific situations might therefore warrant a hug or a touch, Sarkar appears to side with those critics who advise against it in most cases, especially when such touching occurs on a frequent basis.

Bonitz (2008, p. 391), on the other hand, notes that "Physical touch plays an important role in the healing practices and religious ceremonies of various cultures." In addition, the author cites studies that affirm the necessity of touch to human well-being on both the physical and emotional levels. The implication is that, should a therapeutic situation call for the comfort of physical touch, it should be supplied for the sake of the healing process. The author does acknowledge, however, that the therapist should carefully consider the cultural and personal values of the patient before using touch in a therapeutic setting.

In order to examine the potential danger that romantic feelings toward patients might hold in the therapeutic setting, one might usefully examine the general characteristics of those therapists who most easily fall into the trap of sexual advance. Eichenberg, Fischer-Becker and Fischer (2010, p. 1019), for example, include several general traits. Most therapists who are at risk, for example, are experiencing difficult life situations, have narcissistic deficits, and may themselves have been victims of trauma. More general risk factors include male gender, being respected as therapists, and being professionally experienced and active in private praxis.

There are significant dangers inherent in engaging in sexual relationships between clients and therapists, for both parties involved. Clients are vulnerable and may be further traumatized by the contact, whereas therapists are at risk of losing their position, reputation, and potentially their freedom. Similarly, there are also significant dangers inherent in engaging in sexual or romantic relationships with students or employees. A study conducted by MacMahon, for example, notes that this is the reason why there are specific ethical guidelines for such relationships. Students and professors who engage in sexual relationships are often subject to coercion, hindrance in the professional relationship, and ethically inappropriate conduct (MacMahon, 2010, p. 15-17). In addition, professionals may be in danger of legal action by clients who are involved in such relationships (Pope, Tabachnick, and Keith-Spiege, 2006).