I’m heading to Florida tomorrow for a conference. Please pray for my stamina and mental alertness. I am not speaking for a change, I am the student and I want to get all I can out of what I’m learning.
We’ve had lots and lots of responses to all the boundary and consequences questions. Here was one that was also submitted that I think may help you when you seek counseling.
Question: Could you expound on what are “professional boundaries.” All master's level counselors should have had a course in “professional boundaries” but many ministers and lay counselors have not. Clients certainly have not. Your readers need to hear what characteristics make up professional boundaries. There were some statements in your document that infer counselors should not put their feelings and ideas on the client, but some everyday issues like: the appointment setting, checking state rules regarding paying pastoral counselors, when and where to meet a counselor of the opposite sex and touching of any kind.
For someone who has been used to “taking orders” and being shamed, it is hard to recognize when it is happening, especially by a counselor. Examples, not holding the spouse with harmful, bullying behaviors to accountability when it happens in the session, favoritism to one person in couples counseling, having the counselor word the apology for the person but not ever making them say it and own it (It is okay to give an example, but the person responsible needs to practice it and own it and then use it in session). Not letting one person interrupt the other and take over with accusations.
I think your clients would benefit from a “laundry list ” of issues that should make us stop and think twice and we are not the best at seeing the “red flags.”
Answer: Consumer beware – there are good counselors and bad counselors and this question asks what are the red flags that the counselor is either professionally ill-equipped to handle your problem or does not demonstrate good professional boundaries or both? Let me give you some guidelines.
If you go to a licensed counselor, whether that be a psychiatrist, licensed social worker, psychologist, marriage and family counselor or professional counselor, they each have “rules” they are to abide by in order to maintain their professional license.
Here are the three most important:
Informed Consent and Confidentiality: When you go to a licensed counselor, they are required to inform you (before you open your mouth) the rules of confidentiality and what would constitute a breach of confidentiality. This is important because when you go to a counselor you assume everything is confidential. That’s not true.
For example, if you were going to a counselor to get help with your parenting because you were losing it and abusing your child, it would be important for you to know that if you tell the counselor you are abusing your child, the counselor is required by law to report you to the authorities for an investigation of child abuse.
If you didn’t know that ahead of time and you disclosed your problem to the counselor and after you disclosed this, he or she told you, “Well I have to report that” things get very messy. Before your talk with your counselor, usually in the paperwork you fill out, there is information on informed consent that you agree you read, understand, and sign.
In addition a licensed counselor is not allowed to discuss your situation with anyone who calls them without your informed and written consent. That means if your spouse or pastor or concerned relative calls the counselor, the counselor is not allowed to disclose any information about you, not even whether or not you are a client or attending your sessions.
One more thing, If you are using your insurance for counseling understand that your counselor must put a “diagnosis” of you in order for you to be reimbursed. It would be in your best interests to know what diagnosis he or she is putting on that line because that will become a part of your permanent medical record. If your counselor does not offer that information ask her to tell you BEFORE she submits for insurance reimbursement. That way you have a choice as to whether or not you want to use your insurance to pay for your sessions.
Although medical records are confidential, there are some things you should know ahead of time. For example, if you apply for life insurance and you have a history of major depression and that is on your medical records you may be denied. Or, if you are adopting a child and have had a history of depression and have taken antidepressants, you may be disqualified from applying.
We don’t think about these things when we are in pain and want help but there are important issues to discuss with your counselor.
If you go to a church counselor or a non-licensed professional, they are not governed by the same rules so you do not know what their “rules” are around confidentiality and consent. That doesn’t mean they might not be competent to help you but ask questions about confidentiality BEFORE you start to work with them.
Questions to ask your counselor: Is everything we talk about confidential? What are the exceptions? Where do you keep your written notes of our sessions? Who else has access to read or see those records? (They should be in a locked file).If my husband calls you (or someone else), what is your policy about talking with them over the phone about our work together?
If you are comfortable with their answers, ask if they can put this in writing for you so you both are agreed on boundaries of confidentiality. If they are unwilling to do this, think twice.
Relationship boundaries: A licensed counselor is required by law to protect the counseling relationship. Therefore counselors are not allowed to engage in personal relationships with someone who they are professionally helping, even after the counseling relationship is over.
Your counselor is not allowed to go to lunch with you, get together on the weekend for a movie, come to your open house holiday party or receive expensive gifts from you. It is a professional relationship and needs to be protected. An exception might be made if there was a tragedy he or she might come to the funeral, or if they were instrumental in premarital work, or restoring a broken marriage he or she may attend your wedding or a recommitment of vows ceremony (but usually not attend the reception).
This boundary sometimes shocks and hurts clients because the relationship they build with their counselor often starts to feel like a close friendship. It hurts when a counselor says “no” to your invitations. But you only have one good counselor. You can have lots of friends. Trust me, it’s crucial that your counselor protects your counseling relationship and therefore it must stay a counseling relationship.
This also means your counselor is clear on the times you come to her office and how long each session will be. Payment information is also spelled out ahead of time and the ways and methods of contact are understood. She may not want you to e-mail her, text her or use her social media to connect. This is to keep the relationship from sliding into a more personal relationship. Your counselor should let you know the “rules” or boundaries of how she wants to be contacted in an emergency and when you can expect her to respond.
On my informed consent sheet with my counseling clients I spelled out what they could “expect” from me if we ran into each other at church or other settings. This was important for confidentiality reasons. I didn’t want her husband asking, “How do you know her?” or getting hurt because I did not acknowledge I knew her at church. So I said, “I will not approach or acknowledge you if we see each other in settings other than the office to protect your confidentiality.”
With e-mail and internet use so common, the “rules” of engagement between professional and client are being reevaluated by licensing boards and it isn’t always black and white in these matters but the main point is the communication is professional and not personal.
When you are seeing a non-licensed counselor or someone from your church in a lay counselor capacity the rules and boundaries are not so clear. You attend the same church, your kids may be friends, and perhaps you are in a small group together.
I don’t think this is always a bad thing, but it does make things murkier and messier. There are a lot of “one-another” passages in scripture that tell us that we are to come along side one another when we are suffering and for a moment, or a season, one “friend” might counsel another. This is a good thing but boundaries are not as clear-cut or spelled out. If your friend, women’s ministry leader, or pastor, is also your counselor in a more formal way, you may have to set up some temporary boundaries to protect both of you and the relationship.
Here are questions to ask your counselor: Will we have regular appointments times to meet and where? May I call you when I need to? What are your boundaries? (How often, what time limits, cell phone vs home phone vs office phone, weekend calls?) May I e-mail you if I need to? What e-mail address do you want me to use?
If you are in small groups together or have social contacts, talk about how this will be handled.
Touching Boundaries: Human touch is important and a counselor must be wise. We are people and feel deep care and compassion for our clients, especially when we see they are hurting. We often want to hug them or reach out for their hand or put our arm around them but a counselor should never do this without asking for a client’s permission and being extremely cautious about any hint of sexual touch.
Sexual relations of any kind are prohibited between a counselor and client, even if both give consent. If this happens, a counselor will lose his or her license to practice their profession. This is prohibited even after the counseling relationship is over. It is a big NO, NO, and every licensed counselor knows this. If your counselor ever crosses this boundary, you should report him or her to their licensing board for sanctions.
When you work closely with a counselor it’s not uncommon to develop strong feelings and be sexually attracted. Perhaps for the first time you feel cared for and heard. In your confusion you may flirt, be seductive, or even feel like you are falling in love. In your mind the relationship is becoming personal, mutual. It is not or should not.
Your counselor can talk with you about what’s happening but must not encourage you to act on your feelings or show any positive responsiveness to your behaviors. He or she can be empathetic and compassionate, sharing with you that this is not uncommon but will pass. He or she must assure you and remind you this is a professional relationship and it must always stay that way.
Seeing a damsel in distress, especially when she is attractive, can also be a huge turn on for a man, even if he is a counselor or pastor. It pulls at his hero strings. He wants to rescue her from her awful marriage. He wants to help her feel loved for the first time in her life. Sometimes he lies to himself telling himself that God has asked him to “cross” the professional boundary line in order to help her in a special way that no one else can. I’ve seen it happen too many times and trust me it never, ever, turns out good. Your counselor is 100% responsible to hold to the boundary of absolutely no sexual contact, period.
In every profession and church there are predators who are looking for the weak and vulnerable to exploit. The counseling profession is no exception. Please be careful and wise with who you choose to trust, who you open yourself up to help you grow and heal. For that reason if you need to discuss issues of sexual abuse, as a woman you might feel safer with a female counselor, although a female counselor can also be predator.
Some of the other issues raised in the question have more to do with competency issues. Let’s face it; some people are just better counselors than others, just like some hairstylists are better than others. But no counselor is perfect nor will they always do what you think he or she should do.
My husband is a volleyball coach and he gets a number of phone calls and e-mails from concerned parents who think they know better than he does how to strategize the game or how their child should play the game. Counselors have been trained in certain methods of counseling and should have a good reason for why they are choosing one approach over another. You might think they’re wrong in their approach, and If you are uncomfortable with something ask. Speak up. Don’t let yourself be a silent victim in a counseling session. Again, pay attention to how the counselor handles your questions and concerns. Are they open to your feedback? Receptive to your feelings? Willing to listen?
If they do not hear you or invalidate your concerns or bully you into doing something you don’t want to do, this is not the counselor you need.
If you have been used to being controlled in your marriage, the easiest thing for you to do is to slide into being passively controlled by your counselor. He or she may mean well and seemingly have your best interest in mind but right now that is not what’s best for you.
Your counselor’s goal should be to help you get strong and healthy (not stay passive and dependent) so you can make your own good decisions and control yourself (tweet that).
Your counselor is to help you be less man or person-centered or dependent and more God-centered. If that’s not happening or you don’t feel heard, it may be time to find someone who is a better fit.
Please don’t look for someone who says what you want to hear. There are lots of those kinds of counselors too but they won’t help you grow. They will just help you stay justified in your current mindset. You need someone who will speak the truth to you (and your spouse if you’re doing couples counseling) with compassion and grace.
Friends: Have your counselors had good boundaries with you?