1. The Line:
By: Liz Wolf

2. • After two years of seeing Susan, no progress has been
made in therapy. I went to Susan for mental health
issues, Susan has her CAP, and she is an addiction
counselor. In the beginning of the treatment process
there were clear boundaries and goals with Susan. As
time went on Susan and I began to be friends and she
started disclosing her personal life to me such as her
sex life. Then we started going out to coffee and out to
eat, and she started accepting and giving gifts such as
an old laptop I gave her. Susan did not know how to
treat me because I did not have an issue with addiction
I went to Susan for mental health, so Susan went out of
her scope of knowledge and expertise and tried to do
DBT with me, which did not work because she was not
certified in it, did not have the proper training in it and
did not have a supervisor to assist her in DBT training.
Susan also did not have any supervision in any other
issues she was having in treating me. Susan didn’t
know what treatments were effective with me and
how to implement them so I ended up teaching Susan
how to use different therapy techniques and
methodologies such as art therapy. On top of Susan
and me becoming friends, Susan self-disclosing too
much personal information, being incompetent to treat
me, Susan also spoke to my mother without consent
from me.

3. Ethical Codes Broken:
• Lack of boundaries
• Conflict of interest
• dual relationship
• self-disclosure
• Incompetent
• broke confidentiality

4. • “Boundaries help ensure that no
external factors interfere with
the relationship or compromise
the level of care being provided”
(Nickel, 2004).
• “Therapy boundaries provide a
framework that can guide and
manage client expectations of
the therapeutic encounter as
well as distinguish therapy from
other social events in the clients
life. More specifically, client and
therapist roles are maintained
by boundaries intended to
define and delineate behavior
that it acceptable in therapy”
(Audet, 2011).
• “Boundaries help ensure that no
external factors interfere with
the relationship or compromise
the level of care being provided”
(Nickel, 2004).
• “Therapy boundaries provide a
framework that can guide and
manage client expectations of
the therapeutic encounter as
well as distinguish therapy from
other social events in the clients
life. More specifically, client and
therapist roles are maintained
by boundaries intended to
define and delineate behavior
that it acceptable in therapy”
(Audet, 2011).

5. • “Boundary issues occur when social
workers face possible conflicts of
interests in the form of what have
become known as dual or multiple
relationships. Dual or multiple
relationships occur when professionals
engage with clients or colleagues in
more than one relationship” (Reamer,
2003).
• “A professional enters into a dual
relationship whenever he or she
assumes a second role with a client”
(Reamer, 2003).
• “The code goes on to say that social
workers should not engage in dual or
multiple relationships with clients or
former clients in which there is a risk of
exploitation or potential harm to the
client” (Reamer, 2003).
• “Boundary issues occur when social
workers face possible conflicts of
interests in the form of what have
become known as dual or multiple
relationships. Dual or multiple
relationships occur when professionals
engage with clients or colleagues in
more than one relationship” (Reamer,
2003).
• “A professional enters into a dual
relationship whenever he or she
assumes a second role with a client”
(Reamer, 2003).
• “The code goes on to say that social
workers should not engage in dual or
multiple relationships with clients or
former clients in which there is a risk of
exploitation or potential harm to the
client” (Reamer, 2003).

6. • “Therapist disclosure can
infringe upon client
therapist boundaries and
compromise
professionalism” (Audet,
2011).

7. NASW Code of
Ethics:
• 1.01 Commitment to Clients
• Social workers’ primary
responsibility is to promote
the well­being of clients. In
general, clients’ interests are
primary. However, social
workers’ responsibility to the
larger society or specific legal
obligations may on limited
occasions supersede the
loyalty owed clients, and
clients should be so advised.

8. NASW Code of
Ethics:
• 1.03 Informed Consent
• (a) Social workers should provide
services to clients only in the
context of a professional
relationship based, when
appropriate, on valid informed
consent. Social workers should use
clear and understandable language
to inform clients of the purpose of
the services, risks related to the
services, limits to services because
of the requirements of a third­
party payer, relevant costs,
reasonable alternatives, clients’
right to refuse or withdraw
consent, and the time frame
covered by the consent. Social
workers should provide clients
with an opportunity to ask
questions
• 1.03 Informed Consent
• (a) Social workers should provide
services to clients only in the
context of a professional
relationship based, when
appropriate, on valid informed
consent. Social workers should use
clear and understandable language
to inform clients of the purpose of
the services, risks related to the
services, limits to services because
of the requirements of a third­
party payer, relevant costs,
reasonable alternatives, clients’
right to refuse or withdraw
consent, and the time frame
covered by the consent. Social
workers should provide clients
with an opportunity to ask
questions

9. NASW Code of
Ethics:
• 1.04 Competence
• (a) Social workers should provide
services and represent themselves
as competent only within the
boundaries of their education,
training, license, certification,
consultation received, supervised
experience, or other relevant
professional experience.
• (b) Social workers should provide
services in substantive areas or use
intervention techniques or
approaches that are new to them
only after engaging in appropriate
study, training, consultation, and
supervision from people who are
competent in those interventions
or techniques.
• 1.04 Competence
• (a) Social workers should provide
services and represent themselves
as competent only within the
boundaries of their education,
training, license, certification,
consultation received, supervised
experience, or other relevant
professional experience.
• (b) Social workers should provide
services in substantive areas or use
intervention techniques or
approaches that are new to them
only after engaging in appropriate
study, training, consultation, and
supervision from people who are
competent in those interventions
or techniques.

10. • 1.06 Conflicts of Interest
• (a) Social workers should be alert to
and avoid conflicts of interest that
interfere with the exercise of
professional discretion and impartial
judgment. Social workers should inform
clients when a real or potential conflict
of interest arises and take reasonable
steps to resolve the issue in a manner
that makes the clients’ interests
primary and protects clients’ interests
to the greatest extent possible. In
some cases, protecting clients’
interests may require termination of
the professional relationship with
proper referral of the client.
• 1.06 Conflicts of Interest
• (a) Social workers should be alert to
and avoid conflicts of interest that
interfere with the exercise of
professional discretion and impartial
judgment. Social workers should inform
clients when a real or potential conflict
of interest arises and take reasonable
steps to resolve the issue in a manner
that makes the clients’ interests
primary and protects clients’ interests
to the greatest extent possible. In
some cases, protecting clients’
interests may require termination of
the professional relationship with
proper referral of the client.
• (c) Social workers should not engage in
dual or multiple relationships with
clients or former clients in which there
is a risk of exploitation or potential
harm to the client. In instances when
dual or multiple relationships are
unavoidable, social workers should
take steps to protect clients and are
responsible for setting clear,
appropriate, and culturally sensitive
boundaries. (Dual or multiple
relationships occur when social
workers relate to clients in more than
one relationship, whether
professional, social, or business. Dual
or multiple relationships can occur
simultaneously or consecutively
• (c) Social workers should not engage in
dual or multiple relationships with
clients or former clients in which there
is a risk of exploitation or potential
harm to the client. In instances when
dual or multiple relationships are
unavoidable, social workers should
take steps to protect clients and are
responsible for setting clear,
appropriate, and culturally sensitive
boundaries. (Dual or multiple
relationships occur when social
workers relate to clients in more than
one relationship, whether
professional, social, or business. Dual
or multiple relationships can occur
simultaneously or consecutively

11. NASW Code of Ethics:
• 1.07 Privacy and Confidentiality
• (b) Social workers may disclose confidential
information when appropriate with valid
consent from a client or a person legally
authorized to consent on behalf of a client.

12. Florida Statutes & Laws:
• 397.401 License required; penalty;
injunction; rules waivers.—
• (1) It is unlawful for any person or agency to
act as a substance abuse service provider unless
it is licensed or exempt from licensure under
this chapter.
• 397.405 Exemptions from licensure. —The
following are exempt from the licensing
provisions of this chapter:
• (1) A hospital or hospital-based component
licensed under chapter 395.
• (2) A nursing home facility as defined in s.
400.021.
• (3) A substance abuse education program
established pursuant to s. 1003.42.
• (4) A facility or institution operated by the
Federal Government.
• (5) A physician or physician assistant licensed
under chapter 458 or chapter 459.
• (6) A psychologist licensed under chapter 490.
• (7) A social worker, marriage and family
therapist, or mental health counselor licensed
under chapter 491.
• 394.4615 Clinical records; confidentiality. —
• (1) A clinical record shall be maintained for
each patient. The record shall include data
pertaining to admission and such other
information as may be required under rules of
the department. A clinical record is confidential
and exempt from the provisions of s. 119.07(1).
Unless waived by express and informed consent,
by the patient or the patient’s guardian or
guardian advocate or, if the patient is deceased,
by the patient’s personal representative or the
family member who stands next in line of
intestate succession, the confidential status of
the clinical record shall not be lost by either
authorized or unauthorized disclosure to any
person, organization, or agency.

13. Solution 1: Set boundaries with SusanSolution 1: Set boundaries with Susan
Pro’s:Pro’s:
• This is good practice for me
to be assertive
• If boundaries were set it is
more likely that I would get
more out of therapy
• This is good practice for me
to be assertive
• If boundaries were set it is
more likely that I would get
more out of therapy
Con’s:Con’s:
• Could cause awkwardness
between us
• I’m passive
• She could get offended
• Could cause awkwardness
between us
• I’m passive
• She could get offended

14. Solution 2: Terminate treatment and
get referral to new therapist
Solution 2: Terminate treatment and
get referral to new therapist
Pro’s:Pro’s:
• The new therapist might
actually help me
• I could get a therapist that
is trained and educated in
mental health
• I would learn new skills and
coping tools instead of just
sitting around chatting
• Therapy could be
productive
• The new therapist might
actually help me
• I could get a therapist that
is trained and educated in
mental health
• I would learn new skills and
coping tools instead of just
sitting around chatting
• Therapy could be
productive
Con’s:Con’s:
• It would hurt Susan’s
feelings
• It’s hard for me to trust
• It would hurt Susan’s
feelings
• It’s hard for me to trust

15. Best Solution: Terminate and get
refferal for new therapist
Best Solution: Terminate and get
refferal for new therapist
• 1.) Susan broke Florida state law and was unethical by breaking
confidentiality and practicing outside of her knowledge and
expertise.
• 2.) There is a lack of boundaries which is causing a conflict of
interest especially with Susan self-disclosing her personal life; are
we friends or is this a therapeutic relationship?
• 3.) My best interest is not Susan’s first objective, being my friend
and hanging out is
• 4.) Susan accepted a gift from me that was more than $100 and she
gave me gifts as well
• 5.) I’ve seen her for 2 years and have not progressed, learned
coping tools, or skills
• 6.) I don’t have an addiction problem and she is an addiction
counselor, I need to see a therapist who specializes in mental
health
• 1.) Susan broke Florida state law and was unethical by breaking
confidentiality and practicing outside of her knowledge and
expertise.
• 2.) There is a lack of boundaries which is causing a conflict of
interest especially with Susan self-disclosing her personal life; are
we friends or is this a therapeutic relationship?
• 3.) My best interest is not Susan’s first objective, being my friend
and hanging out is
• 4.) Susan accepted a gift from me that was more than $100 and she
gave me gifts as well
• 5.) I’ve seen her for 2 years and have not progressed, learned
coping tools, or skills
• 6.) I don’t have an addiction problem and she is an addiction
counselor, I need to see a therapist who specializes in mental
health

16. References:
• Audet, C. T. (2011). Client perspectives of therapist self-disclosure: Violating
• boundaries or removing barriers?. Counselling Psychology Quarterly, 24(2),
• 85-100. doi:10.1080/09515070.2011.589602
• Clinical social work, family & therapy & mental health counseing: Florida statutes
and rules. (2012). Retrieved from
• http://www.leg.state.fl.us/Statutes/index.cfm?
App_mode=Display_Statute&
• Search_String=&URL=0300-0399/0394/Sections/0394.459.html
• NASW Delegate Assembly. (2008). National association of social workers .
Retrieved from http://www.socialworkers.org/pubs/code/code.asp
• Nickel, M. (2004). Professional Boundaries: The Dilemma of Dual & Multiple
• Relationships in Rural Clinical Practice. Counseling & Clinical Psychology
• Journal, 1(1), 17-22.
• Reamer, F. G. (2003). Boundary Issues in Social Work: Managing Dual
Relationships. Social Work, 48(1), 121-133.