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Setting Clear and Ethical Boundaries with Clients

Section 11
Ethical Issues Relevant to the Assessment of Suicide Risk

Question 11 | Test | Table of Contents

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Here's another thought about acceptance and setting ethical boundaries. You may not have thought that acceptance also involves expectations. Think about it, you not only accept the client for what he or she is, but you accept them for what they are capable of being.

As in the preceding example in track ten of the custody judge, his lack of acceptance of the low social economic family leads him to expect that they would not make good parents. This expectation based on acceptance assumes great significance in setting boundaries. Your expectation of the client's potential influences your attitude and behavior, and may have a bearing on the outcome of your therapy sessions.

♦ Base Expectations on Reality
It cannot be too strongly emphasized, however, that your expectations must be based on reality. These expectations are to be arrived at, as much as possible, without the influence of your biases or stereotypes brought about by your lack of acceptance of a client's actions or situation.

In my mind, there is no area of counseling where this acceptance leading to expectations is more controversial than in the "duty-to-warn" an identifiable other of a threat made by your client. In short, what you expect your client to do determines whether you should set a boundary on your client's behavior by warning the intended victim. Secondly, and of equal importance, is your "duty-to-protect" the client from self-harm.

♦ 5 Boundaries Regarding Suicide
Let's look at expectations as they related to the complication of a suicidal client. I'll be giving you a five point evaluation of boundaries you set regarding foreseeability, and appropriate diagnosis of risk behavior for suicide.
1. The first boundary you set regarding suicide is to ask the question: Was I aware, or should I have been aware, of my client's risk for suicide?
2. The second boundary's question is: Was I thorough in my assessment of my client's suicide risk?
3. Thirdly, did I make reasonable efforts to collect sufficient and necessary data to assess the risk?
4. Fourth, did my assessment data lead to a misdiagnosis?
5. Fifth, do I feel I mismanaged the case, being unavailable or unresponsive to my client's situation? Hindsight is always 20/20. For a client at risk for suicide, the action you took regarding the preceding five boundaries was based upon your expectation as to what you felt the client would do.

The key is, by accepting your client and not judging, you set expectations based on reality...and the setting of boundaries regarding the duty-to-warn and the duty-to-protect are key illustrations of the expectation boundary setting.
Reviewed 2023

Peer-Reviewed Journal Article References:
Berzofsky, M. (2010). Review of Turning points in dynamic psychotherapy: Initial assessment, boundaries, money, disruptions and suicidal cases and The damaged core: Origins, dynamics, manifestations and treatment [Review of the books Turning points in dynamic psychotherapy: Initial assessment, boundaries, money, disruptions and suicidal cases, & The damaged core: Origins, dynamics, manifestations and treatment, by S. Akhtar & S. Akhtar]. Psychoanalytic Psychology, 27(4), 539–540.

James, K., & Stewart, D. (2018). Blurred boundaries—A qualitative study of how acts of self-harm and attempted suicide are defined by mental health practitioners. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 39(4), 247–254.

Pinner, D. H., & Kivlighan, D. M. III. (2018). The ethical implications and utility of routine outcome monitoring in determining boundaries of competence in practice. Professional Psychology: Research and Practice, 49(4), 247–254.

Wilson, C. M., & Christensen, B. K. (2012). Ethical issues relevant to the assessment of suicide risk in nonclinical research settings. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 33(1), 54–59.

Wu, K. S., & Sonne, J. L. (2021). Therapist boundary crossings in the digital age: Psychologists’ practice frequencies and perceptions of ethicality. Professional Psychology: Research and Practice.

QUESTION 11
By accepting your client and not judging, you set expectations based on what? To select and enter your answer go to Test.

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