Vignette Case

You have been treating an Hispanic-American gentleman diagnosed with a severe mental illness for several years. You currently seem him twice monthly for stabilization therapy. He recently lost his job, his medical insurance, and is in danger of losing his home. This gentleman feels he owes his life to you and does not want to terminate therapy, but he fears he will lose his ability to see you due to finances. He asks if there is any way he could do handyman work for you around the office to pay for his therapy. You were planning on having your office painted, getting some repairs done, and other upgrades anyway.

What boundary issues and therapeutic concerns do you see?

I see initial boundary and ethical considerations involving multiple relationships and

bartering. The underlying issues of multiple relationships are rather complicated, and can only

be fully understood within the context of therapy. In this situation, I have been treating a

Hispanic- American man with severe a severe mental illness. Although he can no longer pay for

my services, I believe it is still my duty to evaluate an alternative plan so that he can continue to

receive treatment. Practitioners must evaluate the risks of any potential boundary crossing, as

well as be aware of the clients' emotional vulnerability in times of hardships (Welfel, 2013)

My primary obligation is to promote my clients wellbeing. To serve as my clients

therapist, and his boss, if I was to hire him as a freelance handyman for my office, puts this

situation at risk for potential boundary issues. As articulated in Principle A: Beneficence and

Nonmaleficence psychologist seek to safeguard the welfare those whom the work and avoid or

minimize harm when conflicts occur among professional obligations (Fisher, 2013, p.95). In

order to agree to enter into a multiple relationship with my client I would need to confirm that

bartering for services rendered won't impair my objectivity, competence or effectiveness of the

treatment. It is understood that not all multiple relationships are unethical, and this case scenario

deserves further investigation into judging ethicality of multiple roles.

In regards to bartering, Section A.10d. Bartering, states that counselors may participate in

bartering if it is not exploitive or harmful and does not place the therapist an unreasonable power

advantage over the client (Welfel, 2013). Being that my client ethnicity is that of a Hispanic-

American, I must also take into consideration cultural implications of bartering. I have to

consider if our agreement would be a fair exchange, and if there are any unforeseen cultural

implications that I may be unaware of.

Section 6.05 Barter with Clients/Patients specifically states "barter is the acceptance of

goods, services, or other non-monetary remuneration from clients/patients in return for

psychological services" (Welfel,, 2013, p. 246). One of my concerns would be regarding

jeopardizing our therapeutic relationship if I was not satisfied with my clients "handyman" work.

For example, if my client completes the painting of my office in an unsatisfactory manner, I

would have to ensure that it would not endanger my neutrality and compromise my objectivity.

Another problem would be the difference in cost between our services. "Bartering goods in

somewhat less complicated, because a market value for a good can be independently established,

but even such arrangements can be problematic" ( Welfel, 2013, p. 247). In this situation, my

client is offer a service, which makes evaluation of pricing even more difficult. To make things

even more difficult, if I was completing dissatisfied with my clients work, I may have limited

legal recourse due to confidentiality laws. The risks involved in the agreement between my

services, and my clients handyman work, would require further investigation.

How would you go about your decision making process?

Before deciding on this case scenario, I would implement principle based ethics five step model

for decision making. This model consists of a step-by step formula:

1) Identify or scrutinize the problem

2) Develop alternatives or hypothesis

3) Evaluate or analyze options

4) Act or perform

5) Look back or evaluate (Knapp & VandeCreek, 2012, p. 39).

Step one involves identifying the problem, and in this situation I am mostly concerned about

bartering issues. Although I understand that bartering is fairly common practice, I am not sure if

I would be comfortable hiring my client to help renovate my office space. At this point I am

unsure about the quality of his work. I do not know if there is a way for him to check his work

references, if I am not able to call them due to confidentiality laws. I am also concerned what

may happen if I he services elicited a negative response, and how he would be able to handle it

on an emotional level. Just because someone prides them self of excellent work, does not mean

the work is excellent. This disagreement may put my client in a vulnerable emotional