Principles Underlying a Model Policy on Relationships Between Staff and Service Recipients in a Mental Health System

Abstract

The work group formulated five guiding principles: prevention of the exploitation of recipients of services by staff; the right of recipients to be treated as competent autonomous human beings; recognition that certain developmental stages, treatment settings, and pre-existing relationships increase a service recipient's vulnerability to exploitation and call for more stringent regulation of staff actions; acceptance of a spectrum of permissible relationships for staff and recipients outside of the relationship dictated by the staff member's job description; and recognition of the difference between a relationship focused on treatment or service provision and other professional relationships between providers and current or former recipients. The principles were used to develop a model policy on relationships between staff and recipients that addresses both the organizational complexity and the recipient-centered rehabilitation model of a large state-operated mental health system.

To cross or not to cross: Clinical boundary considerations with persons who are refugees

“…The focus on sexual abuse occurring in therapy has, in essence, shifted the more general discussion about boundaries away from examining and defining the evolving relationship between clinician and patient to infrequent but highly dramatic and prurient boundary violations, even lending a hint of illicitness to allowing the development of warm or interactive connections in a therapeutic relationship. In reporting on the conclusions of a New York State Office of Mental Health work group that was assigned the task of addressing overall relationships between staff members and service recipients, Fisher and Goldsmith (1999) commented on the frequency with which discussions of boundaries in the psychiatric literature were narrowly focused on sexual relationships between therapists and patients, and how ''many of the general discussions of boundaries are framed around a 'slippery-slope' hypothesis that categorizes all boundary violations as potential steps on the road to a sexual relationship between the therapist and the patient'' (p. 1448).…”

Exploring Boundaries in the Nurse-Client Relationship: Professional Roles and Responsibilities

“…More recently, agency-specific tools and guidelines are emerging within practice, for example: (a) the Rainbow Therapeutic Decision-Making Framework, developed on a pediatric unit as a proactive measure to assist nurses in managing their relationships with clients and families (McAliley et al, 1996); (b) a Model Relationships Policy developed specifically to meet the needs of a complex state operated mental health system (Fisher & Goldsmith, 1999); and (c) the Relationship Security Risk Warning Signs Self-Assessment Checklist, developed by the Clinical Safety Project at Atascadero State Hospital, to be used by therapists working with forensic clients (Love, 2001a). Although a complete listing of the principles and questions contained within these documents is beyond the scope of this paper, common to all are questions that relate to time spent with particular clients, both on and off duty; feelings about particular clients (viewing clients possessively [i.e., "my client"], or seeing the client as special); issues surrounding self-disclosure, role reversal, and personal needs; fantasizing about the client; and issues related to overidentification.…”

“…Although guidelines for every eventuality are unlikely, contextspecific hypothetical scenarios can be used to stimulate exploration and deliberation of differing views and provide recommendations for practice. Such guidelines would reflect a proactive approach and take into consideration the complexities of the treatment environment, the nature of the clientele, and the competence of the clinicians (Fisher & Goldsmith, 1999;Gallop, 1998b;Peternelj-Taylor, 1998;Walker & Clark, 1999). As a clinical risk-management strategy, Love (2001b) further recommends orientating clients to the purpose of boundaries in therapeutic relationships.…”