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Of course, therapists must be aware that some situations—for instance, cases involving custody, repressed memory, and complex PTSD issues or clients who are highly paranoid, aggressive, dissociative, antisocial, or litigious—may present higher levels of risk than others. Additionally, boundary issues should be handled with extra care with clients who have serious personality disorders, such as borderline or narcissistic personality disorder, or those who view themselves inherently as victims.

If we try to combine the role of lawyer and therapist, we'll inevitably make a hash of both. The best and truest kind of "risk management" isn't motivated by fear of taking a wrong step or making a wrong move: it's based on therapeutic competence; knowledge of the laws and codes of ethics; a deep commitment to our clients' welfare; our own maturity, professional development, and common sense; and our ability to think critically, work only within our scope of practice and competence, and carry out an ethical decision-making process. Then, of course, we must bear in mind the importance of informed consent, thorough documentation, and consultations. Without these qualities, we won't be good therapists, no matter how much case law we memorize.

Ofer Zur, Ph.D., is a forensic expert, consultant, author, and psychologist practicing in Sonoma, California. His recent publications include Dual Relationships and Psychotherapy, coedited with Arnold Lazarus, and the bestselling HIPAA Compliance Kit, now in its third edition. His most recent book is Boundaries in Psychotherapy. Dozens of free articles are posted at www.drzur.com. Contact: drzur@drzur.com.

Tell us what you think about this article by leaving a comment below or sending an email to letters@psychnetworker.org.

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stephen144  - Appreciative of clear thinking   |Registered |2011-02-25 13:19:06
I appreciated this article and your presentation on Digital Ethics. You made a
convincing argument and a clear distinction between standard of care and risk
management... very useful.

Thank you.
ivkennedy  - LCSW   |Registered |2011-02-24 10:22:07
Dr. Zur, Your presentation on digital ethics has been so helpful. The
information is good. Your emphasis on the importance of therapeutic competence
rather than fear and risk management offers more possibilities for solutions to
these dilemmas. Your ideas are refreshing and show you are a curious and
creative clinician. Thank you.
ggro@comcast.net  - The ethical eye   |Registered |2011-02-24 09:08:15
This is the clearest article on ethics that I've ever read. It is a much needed
rebuttal to the fear mongering that is so prevalent today. My thanks to the
author for both his learned and common sense thinking.
snordquist  - Thanks for clarity   |Registered |2011-01-23 00:22:30
For a new PsychoSocial Rehabilitation Practicianer working with children and
adolescents, I found freedom and wisdom in learning the ethical boundaries,
learning the importance of good records, and consulting with trusted colleagues
for advice. I'll be reading more of your articles at your website.
mitelpunkt   |2011-01-05 20:58:11
I don't remember who said that "there are patients that we build a set to
treat them, and patients that we treat them to build a set".
The most
impressive change in a psychotic patient acurred once that a made an "acting
out" inviting him to a drink. After this event, very significant in
repairing his (and mine) relation with his father, he never again felt inot
psychotic states!!!
I was then affraid of bringing it to supervision, I never
did it, but it was a truely therapeutic act.

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