A Question of Boundaries

Teresa, a professional counselor moved to a small town in Iowa with her 13 years old son. She discovered that except for apsychiatrist, the closest other mental health professional practices approximately 1½ hours away. Initially, she felt isolated and found it emotionally and financially difficult to establish her private practice, adjust to small town living, and develop a personal life.
After almost a year of struggle, her practice is fairly steady and her son is doing quite well in his new school. Teresa has become close friends with Evelyn, the principal of her son school. In fact, her son and Evelyn’s son have also become very close friends and spend a good deal of time in each other’s home. Teresa and Evelyn discovered many commonalities, including that they are both divorced, received little support from their ex-husbands, and originally from large cities. They carpool, watch each other’s children, socialize together, and have become strong social and emotional supports for each other.

Teresa and Evelyn spend a good bit of time commiserating on the joys and problems of being single parents and the difficulties of dealing with teenager’s sons. Evelyn confides that she is really concerned about her son, Chris, stating that he is having a lot of problems in school and that their relationships at home has become strained . According to Evelyn, Chris seems to be testing her authority and recently has been lashing out at her, especially in matters related to school. Evelyn tells Teresa that most of Chris problems are caused by his inconsistent communication with his father and shares that she is at her wit’s end. She thinks Chris needs counseling and asks Teresa to take him on as a client.

Teresa is initially reluctant and explains to Evelyn that she is concerned about how this may affect their friendship. They discussed the differences between friendships and professional relationships and how these differences may manifest themselves in their almost-daily contacts. Evelyn insists that she feels comfortable with the duality and that she doesn’t see a necessity to make a 3-hour drive, round trip, when Teresa is well qualify to work with her son. Teresa is concerned that if she refuses Evelyn’s request, it may damage their friendship. She is also fairly sure that she would do no harm in providing counseling to Chris and agrees to see him in a weekly basis in her office.

During their second session, Chris shares that he is uncomfortable talking about some of the things that are bothering him, particularly anything to do with his mother. Teresa discusses confidentiality issues, and eventually Chris seems to relax and open up. During the course of treatment, he divulged information about both of his parents that leads Teresa to believe that Chris is reacting to more than inconsistent communication with his father and that some of Evelyn’s behaviors are contributing to her son’s problems. One example Chris brings up in a counseling session is that his mom often complains to him about his father, and this upset him. Teresa struggles with how to explore this with Evelyn. Discussing it in the office with her and her son, as she may with other clients, seems too formal, given their friendship, but Teresa believes it would unethical to discuss this with Evelyn over coffee without Chris. She decides to wait and see what else Chris may bring up in sessions.
Teresa also notices that when Chris is at her house with her own son, she feels uncomfortable. She realizes that she is shifting back and forth between the unconditional positive regard she tries to exhibit in her office and the realities of having to discipline two teenagers who sometimes get a bit out of hand. She brings this up with Chris during their next session, explaining that she is wearing different hats: in the office she is counselor, and at home she is his best friend’s mom. He seems to understand, but Teresa finds herself becoming increasingly uneasy as the weeks pass, especially after a few incidents at her home when Teresa finds the boys breaking house rules by smoking cigarettes and playing music much louder than allowed. When writing her case note, Teresa realizes she is spending a good bit of time sorting through what she knows about Chris from his time in her home versus what he discloses in his counseling sessions. In addition, she becomes aware that she is measuring her words more carefully when she is with Evelyn, thinking about what she should and should not say to her friend in social situations. Teresa wonders how all of this might be influencing her effectiveness in her counseling with Chris. She is having trouble sorting through her current situation: what might be detrimental to Chris, to her friendship with Evelyn, and to herself. After the sixth counseling session with Chris, Teresa decides to consult be phone with a previous supervisor whom she trusts.

Give a brief description of an ethical dilemma related to boundary issues from this case study.
Analyze how you would address each of these dilemmas, citing the appropriate ethical codes.
Describe the ethical decision-making model you utilized in this process and explain why.