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Boundary Crossings and the Ethics of Multiple Role Relationships - Test
by Gerald P. Koocher, Ph.D., ABPP and Patricia Keith‑Spiegel, Ph.D.

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1. The most frequent basis of ethical and licensing complaints against mental health professionals involving clients is:	Help
Incompetence. Fee disputes. Inappropriate relationships/boundary violations. Breaches of confidentiality.

2. Those who do not believe in keeping firm professional boundaries with clients contend that those who do:	Help
Harm the formation of empathy. Are not relating to their clients as human beings. Harm the natural process of psychotherapy. All of the above.

3. The primary reason for keeping appropriate boundaries with one's clients is to:	Help
Ensure that therapists focus only on objectively applying a specific therapeutic technique. Maintain a reliable set of boundaries on which the client and the therapist can always depend. Make sure that no touching occurs. Maximize the client's satisfaction with therapy.

4. Multiple role relationships are said to occur when a therapist is in a professional role with a person and is also:	Help
Involved in another role with the same person. In a relationship with someone closely associated with or related to the person with whom the therapist has the professional role. Making plans together to enter into another relationship in the future. All of the above

5. The risk of role conflict, according to Kitchener, occurs when:	Help
Expectations in one role involve actions or behavior incompatible with another role. The therapist does not agree with the client's perception of the therapeutic issues. The recommendations of therapists are ignored by the clients. The power and prestige of the client exceeds that of the therapist.

6. Which of these situations that can occur during a therapist's mid-career years is LEAST likely to contribute to making poor professional judgments and decisions?	Help
Divorce Gaining weight Problems with one's teenagers or young adult children Disappointment that one's youthful life goals never materialized

7. It is sometimes difficult for therapists to recognize when professional boundaries are becoming blurred or complicated. Which of the following is an early warning sign for therapists?	Help
Feeling entitled to most of the credit if a client improves Viewing clients as the central people in their lives Allowing a client to take undue advantage without confrontation (e.g. missing many appointments) All of the above are correct answers.

8. Which of the following dissatisfactions might arise during bartered therapy sessions?	Help
The client might resent having to work too many hours to make up for one expensive therapy session. The client could become dissatisfied with how the therapist treats him/her in this different role. The therapy relationship may become confusing and more complicated. All of the above could happen in therapy bartering arrangements.

9. One of the main problems that can arise when determining what a tangible good is worth for the purpose of bartering in exchange for mental health services is that:	Help
It is often difficult to determine fair market value. Clients are very likely to overvalue what they want to exchange. Therapists are very likely to undervalue anything they are willing to accept. It is unethical to accept anything worth more than $100 in a bartering agreement.

10. What is an important bartering complication that is not often discussed?

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Liability insurance carriers may interpret bartering arrangements as business relationships, which they typically exclude, and decline to defend covered therapists when bartering schemes go awry.
Unless the fair market monetary value of bartered goods or services is reported as income on the recipient's income tax returns, the therapist may be committing tax evasion.
To fully meet legal requirements involved in bartering requires detailed documentation, thus creating another complex and nontherapeutic interaction with the client.
All of the above are correct answers.

11. A close friend (or family member) needs therapy. She asks to become one of your regular ongoing paying clients. What is your most ethical response?

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Because trust has already been established, try it out first for five or six sessions to see how it goes.
It is acceptable to treat close friends and family members so long as you do not charge a fee.
It is acceptable to give general advice, especially in an emergency, but as soon as feasible make a referral to an appropriate colleague.
Inform your friend or family member that you cannot discuss any personal issues with them.

12. Which gift should a therapist refuse?	Help
A batch of homemade cookies A homemade holiday card A nude calendar A package of pencils.

13. Veronica, a soon-to-be terminated client of Dr. Bernard, invites him to her law school graduation ceremony. Dr. Bernard decides to attend the ceremony to celebrate this momentous occasion in his client's life. As a gesture of kindness Dr. Bernard also decides to give Veronica a gift. Which one of the following would be considered the most appropriate gift for Veronica?	Help
A gift certificate for a massage A nice card with a one hundred dollar check A cute card with a "last sessions are free" message A book by a famous legal scholar

14. Which of the following statements regarding service delivery in rural settings is FALSE?	Help
Role clashes become impossible to avoid for mental health professionals working in small or isolated communities. Face-to-face contacts with clients outside of the office inevitably occur. The need for services in rural areas often exceeds resources. Residents of small communities are often less hesitant to seek professional counseling and quickly trust outsiders.

15. Which of the following may help resolve some of the accessibility and therapy boundary problems that often exist in rural or smaller isolated communities?	Help
Teletherapy-based delivery of therapy Stricter ethical standards regarding therapy in rural towns and isolated communities The large number of therapists who are expected to move into small rural and isolated communities within the few years. More reality television shows on how to solve emotional problems

16. Most therapists who have had unintended encounters with ongoing clients express all EXCEPT which of the below?	Help
Surprise Amusement Uncertainty about what to do Anxiety

17. Regarding chance encounters with clients outside of the therapy setting, your lesson authors suggest:	Help
Initiating a chat with them, as if they were family friends. In an early therapy session, explain that the client should take the lead to ignore or greet the therapist, and the therapist will follow. Always ignore them. Discuss how the therapy is going.

18. Some settings where therapists work mandate dual roles in a way that place the therapist in the middle, forcing choices of what loyalties or rules to honor. Which of the following is an example of this kind of work setting?	Help
The Military Prisons Schools All of the above

Boundary Crossings and the Ethics of Multiple Role Relationships - Test by Gerald P. Koocher, Ph.D., ABPP and Patricia Keith‑Spiegel, Ph.D.

Boundary Crossings and the Ethics of Multiple Role Relationships - Test
by Gerald P. Koocher, Ph.D., ABPP and Patricia Keith‑Spiegel, Ph.D.