In the US, there has been an increased demand for mental health counselors in recent years due to more Americans seeking out assistance to learn coping skills, behavioral modifications and new perspectives to improve their overall quality of life. The stigma surrounding mental health services has been decreasing, and a survey revealed that 47% of Americans think so. Those from 18–44 years old, especially women, are the most likely to receive treatment. The growing demand for mental health services, however, highlights the country’s shortage of professionals in this field. The Substance Abuse and Mental Health Services Administration predicts that by 2025, there will be an additional need for marriage and family therapists.
Those who are looking to start a career as a therapist and are wondering where do mental health counselors work, there are many job openings. From hospitals to schools, residential facilities and workplaces. More and more counselors and therapists are needed to improve mental health wellness across the country. By doing an online mental health counseling degree, students will get the skills and develop their experience to start their career in a mental health setting.
This article will have a look at ethical practices one needs to observe as a therapist and how to set clear boundaries with clients.
Therapists’ ethical practices
Ethical considerations should always be a priority in counselor and client relationships. When deciding if one has the necessary experience to assist a client, what type of treatment to provide, or if a client requires more support, consider the ethical obligations. To run an ethical practice, one should look to the regulatory and governing institutions that provide a code of ethics, such as the American Psychological Association (APA), American Counseling Association and the International Coaching Federation. The two main boundary violations to consider are competence and multiple relationships.
Boundaries of competence
With boundaries of competence, the APA’s (2017) code of ethics states that counselors should only offer services within their expertise. If an understanding of individual demographic factors is necessary for constructive therapy and the therapist does not have this knowledge, the client is supposed to be referred to someone who does.
Multiple relationships refer to when a therapist is working with an individual and engages in or promises to assume another role with that individual or another person closely related. Some of these roles are engaging in sexual relationships, business, social or even family-oriented relationships. A therapist is warned to avoid such relationships as they might impair their competency and objectivity, therefore causing harm or exploitation to the client.
On the bright side, not all multiple relationships are condemned. Despite the potential harm to a client that can result from these types of situations, there are times when they are unavoidable. When this occurs, best practice suggests that a therapist should have a consultation with their colleagues and check the pertinent code of ethics (Barnett & Hynes, 2015).
Tips to establish boundaries with clients
As noted earlier, boundaries differ depending on the approach of therapy style used. In addition to the competence and multiple relationship boundaries, a therapist should observe them when it comes to physical touch, gifts, communication channels, fees or payment modes, session duration and location, and contact when not in the therapy session. Clear boundaries always act as a foundation to gain trust and map the behavior of the client and psychologist. Here are some ways a therapist can communicate boundaries with their clients:
Utilizing contracts and obtaining permission through informed consent
Prior to beginning therapy, it is essential to receive informed consent from clients. The beginning of the therapy can be an opportunity for setting up regulations and protocols for suitable communication and behavior. Creating a unified set of client onboarding materials is a great way to set expectations. This can be achieved digitally using blended care tools, for example, Quenza. Digital agreement and consent forms can be advantageous for practitioners as it helps to create comprehensive and accurate records.
Take care to adhere to the session time limits agreed upon in the therapy-client contract or during the informed consent process. Additionally, be sure to set clear expectations about being punctual and what the repercussions will be for clients who come late to sessions on a regular basis. When one catches themselves answering client emails or phone calls during times that should be spent on other tasks or disregarding other arrangements, take a moment to reconsider. Mental health is also of utmost importance so have clear boundaries to avoid burnout.
It might be useful to remind clients of the limits established for communication at the start of the therapy and inform them of when it is appropriate to expect a response. If a therapist habitually goes beyond the scheduled time with certain customers during in-person sessions, put a clock in a noticeable but unobtrusive place. Bear in mind that it is acceptable, and even advantageous, to take a look at the clock occasionally to stay within the allotted time with the client.
Be cautious with self-disclosure
The American Counseling Association emphasizes that when employed judiciously, professionally and aptly, counselor self-disclosure can be a powerful tool in improving the therapeutic relationship and deepening trust and empathy. Conversely, if used too frequently or inappropriately, it can take the attention away from the client and impede their development (Bray, 2019).
Prior to self-disclosure, therapists should evaluate any potential reasons for doing so, like seeking personal validation, and contemplate whether what they share may damage the client’s view of their capability or professionalism.
Be aware of emotions
If a counselor has a strong enthusiasm for spending time with a certain customer, delve into this excitement with a supervisor or during a consultation session. It might be nerve-racking to talk about social or romantic emotions regarding a client with a coworker or supervisor, yet this is an ideal opportunity to take advantage of consulting. A counselor should discuss with their coworker or supervisor the feelings they are experiencing and come up with a plan to handle or resolve them.
Think about the consequences of physical contact
The likelihood of therapists utilizing physical touch may be determined by the type of training and therapeutic approach they have received. For example, those trained in analytical therapy may be less likely to hug their patients, while those with a more humanistic approach may be more inclined to embrace their clients.
It is vital to consider one’s own boundaries and those of the client when engaging in physical, nonsexual touch, as well as make certain that the client is in a position of power. Not only is this ethically sound, but it is also of utmost importance.