Fiduciary Duty and Boundaries: Acting in the Client's Best Interest

Abstract

The task of defining boundaries and boundary violations in the therapeutic relationship is examined from several perspectives. This paper reviews the ethical rules of the major mental health associations and the American Medical Association to determine the professions' ethical positions with regard to boundary maintenance and boundary violations. It also analyzes judicially sanctioned causes of action for recovery by clients for damages suffered as a result of boundary violations. The authors examine the ways in which fiduciary theory is used in the formulation of the ethical rules and to support the imposition of civil liability for boundary violations. The authors conclude that fiduciary theory provides a useful paradigm for setting and evaluating boundaries that acknowledge and address the fiduciary nature of the therapist–client relationship. The authors point out that measuring boundary violations with the yardstick of fiduciary duty serves the interests of both the client and the therapist. © 1997 John Wiley & Sons, Ltd.

Multiple Relationships Between Graduate Assistants and Students: Ethical and Practical Considerations

“…Not all of these relationships can or should be avoided, but the graduate student must acknowledge his or her own responsibility to avoid exploitative or harmful multiple relationships because of the multiple roles in which he or she serves. Appropriate ethical behavior is likely even less clear in the area of nonsexual multiple relationships than with sexual relationships (Jorgenson, Hirsch, & Wahl, 1997), further highlighting the need for education of undergraduate students, graduate students, faculty, and administrators regarding the potential benefit and harm of multiple relationships. In addition to clear institutional guidelines, appropriate training, and ongoing supervision regarding multiple relationships between teaching assistants and students, the strategies detailed in the following paragraphs will aid graduate assistants in preventing harmful relationships and provide a starting point for a discussion of these issues between graduate assistants and their supervisors.…”

“…Acknowledge the power and responsibility of a faculty role (Biaggio et al, 1997). Any graduate assistant-student relationship is a fiduciary relationship, in which trust and confidence are provided for the graduate student to act in the student's best interest (Jorgenson, et al, 1997). Although it is unlikely that the level of self-disclosure in the graduate student-undergraduate relationship will rival that of the therapist-client relationship, transference may still be present in these mentoring relationships (Plaut, 1993).…”

Mentoring, boundaries, and multiple relationships: opportunities and challenges

“…Further, psychologists have a fiduciary responsibility to those they serve professionally. Jorgenson, Hirsch, and Wahl (1997) noted that:…”

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

“…Boundaries are also described as the l i m i t s of the fiduciary relationship, "one in which a person with particular knowledge and abilities accepts the trust and confidence of another to act in that person's best interest" (Penfold, 1998, p. 19). As a matter of law, the professional relationship is a fiduciary relationship (Jorgenson, Hirsch, & Wahl, 1997), and the power differential that exists between a client and a nurse cannot be overlooked. By its very nature, the therapeutic nurse-client relationship is asymmetrical.…”

“…In fact, some authors have argued for a higher fiduciary responsibility when working with clients who present with mental health issues. The combined impact of the isolation of the work, the environment in which the treatment takes place, the length and intensity of the relationship, and the client's vulnerability must be considered when creating, managing, and evaluating boundaries in the therapeutic relationship (Bachman et al, 2000;Durkin, 2000;Jorgenson et al, 1997;Plaut, 1997). Walker and Clark (1999) have concluded that working with clients in less structured environments (e.g., in the community, in their homes), can result in a relaxation of professional roles, particularly when much of the work may take on the appearance of being more social in nature (which can be confusing for the client), which results in an increased obligation to protect the vulnerable client.…”