Vignette Case
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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 wont 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:
Identify or scrutinize the problem
Develop alternatives or hypothesis
Evaluate or analyze options
Act or perform
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