Patients who you know personally

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gez1809
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Patients who you know personally

Post by gez1809 » Mon Jul 07, 2008 11:58 am

What are the BPS' guidelines regarding having clients who you know personally (friends, family etc.)? Is it written that you are not able to accept them as patients, or is it more to personal preference and whether both parties are comfortable with it?

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ems
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Post by ems » Mon Jul 07, 2008 1:34 pm

Off the top of my head, ethically I believe it's a big no no.

It's certainly something I would steer clear of at all costs - dual relationships can cause numerous often unforseen difficulties.

Does anybody have the link for the BPS code of conduct - there's stuff about it in there???

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Dr.Dot
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Post by Dr.Dot » Mon Jul 07, 2008 1:48 pm

It is the BPS (1995) professional practice guidelines that you need to refer to.


Dual relationships are at times unavoidable.

With friends and family there are lots of transference issues and confidentiality concerns when they are clients.
Dorothy: Now which way do we go?

w013
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Post by w013 » Mon Jul 07, 2008 4:26 pm

This might be such a no-no that the BPS have never even thought to say it is not permitted. so don't think it is ok if the BPS have not explicitly banned it.

Presumably this is in some kind of (psycho)therapeutic context?

I think that it is such a big no no that you should not even consider it. You need to be clear about the boundaries - friends, family may not have any realistic way of knowing what therapy involves or how it will impact on them. Therefore they cannot give informed consent.

The potential for problems is huge, your boundaries would certainly be compromised and the issue of confidentiality is immense. I cannot think of any reason that would be sufficient to overcome those issues.

Sorry to sound so emphatic but this is absolutely an absolute.

There are of course some grey areas e.g. what should you do if a neighbour e.g. address on the same long road but you don't know them personally is referred? Another one would be when you know that someone is related to or known to a personal friend of yours or when someone's social circle overlaps with your own. Here things are not so simple. I would always decline to take on someone where i t hought there was a reasonable chance of meeting socially. I have friends who deliberately work in a geographical area away from their home so that the chance is minimised.

Anyway this is a minefield: please don't step into it.

gez1809
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Post by gez1809 » Mon Jul 07, 2008 5:13 pm

it's nothing I was planning on doing, just something my girlfriend mentioned yesterday and I was unsure whether it was explicitly written that it was against BPS guidelines. I've no intention of actually doing it!

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miriam
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Post by miriam » Mon Jul 07, 2008 6:07 pm

I'm with w013 on this one. You can't hold both roles. In a work context it would be hugely unprofessional to offer a professional service to someone you know out of work. In a social context it is a recipe for disaster to try to offer professional advice or therapy to a friend or relative, because the roles are blurred.

Our service was recently referred the child of someone who I recognised had once done a visit to my home (lets imagine they were a mobile hairdresser or a plumber that I had used once). We discussed it in the team and decided that even this one off neutral contact was enough that I shouldn't have any involvement with the family professionally. It was partly inappropriate to work with a client who knew my home address, and partly inappropriate that the relationship was not starting from negotiating a therapeutic contract, but had already been established in a different context.

It is wise to be very conservative about your professional boundaries. Getting into role confusion is easy, but getting out is much more difficult. Prevention is much better than cure.
Miriam

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katyboo
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Post by katyboo » Wed Jul 09, 2008 12:35 pm

i think its a big no-no too and there is no good therapeutic rationale for working with someone you have a dual relationship with. personally i would be very uncomfy with it for both my and the clients privacy and don't think it would be possible to boundary your therapeutic work effectively.

astra
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Post by astra » Wed Jul 09, 2008 2:51 pm

Definite no-no for all the reasons people have cited above.

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Dr.Dot
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Post by Dr.Dot » Wed Jul 09, 2008 4:13 pm

It is a definate no-no, but there are times when you may be aquainted with a prospective client, but there may be nobody else to work with them. For instance if you work in a very rural area with other CP that is able to take the case logistically (say the next service is 60 miles awayor more) . Say for example it is an older adult who lives in an isolated village and you live in the next village along. The person is blind through glacouma, is physically impaired has a dementia and is at risk of self-harming. Do you not work with the person because you have met with them at the village fayre and the christmas carol concert for the last 5 years, or leave them at risk. Ethically dodgy not to.
Dorothy: Now which way do we go?

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miriam
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Post by miriam » Wed Jul 09, 2008 5:56 pm

The examples you give, Dorothy, involve very peripheral knowledge of people, so I think some discretion could be used.

However, even if you are the only CP covering a certain client group in a certain area, there is room to negotiate with a colleague from a different speciality or area, if this would prevent placing you in a compromising position professionally. For example, it would be legitimate for a GP to refer a relative of a member of staff to a neighbouring service, or to a specific named individual with a request for confidentiality from the rest of the team. For example, I've seen as clients relatives of other members of staff and kept the file out of the general filing system and discussed with the client how else we could ensure confidentiality (for example, by what venue we use for appointments, and who they would telephone if they had to re-arrange an appointment).

However, for some clients it is not an issue at all - I recently had a family ask if they could say hello to someone who works in my building that they recognised from the staff photographs, as they went to the same church. They clearly didn't mind him knowing that they had seen a psychologist (and I checked with the member of staff that he was comfortable to say hello to them whilst in work mode). However I would have been very cautious about confidentiality if that member of staff had access to our records, as it wouldn't be right for him to know why they were seeing me unless the family chose to tell him.
Miriam

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Pickle
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Post by Pickle » Sat Jul 26, 2008 2:03 pm

I've had the reverse of this happen and I have to say I did feel very uncomfortable. I happened to go to a family friends' bbq only to see a client whom I'd supported a couple of months earlier.

The ex-client didn't have any problems asking me if 'I was who they thought I was', however, I was very conscious of the fact that people were drinking and could they have had a drink too? And would they have wanted to acknowledge me in that capacity had they not had a drink? Without letting the conversation go a word further I had to very politely and tactfully change the subject.

This was the first time I'd ever encountered such a situation so I hope I did the right thing in diverting the conversation away to a much more neutral topic. I may have handled this differently if the client had been stone cold sober...but then again the client may never have raised the subject in the first place...

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