Objectivity and transference

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Your textbook presents several examples of situations where objectivity and transference might impact a therapeutic relationship. There is often a continuum that ranges from emotional objectivity to transference that can completely impair judgment. Select a scenario from the Cooperative Learning Exercise on page 260 of your textbook, or provide an example from your experience where there was a real or potential loss of objectivity or transference.

In your initial post, describe the difference between emotional objectivity and transference. Describe the scenario you selected and explain where or how the loss of objectivity or transference might occur in the scenario.

241

C H A P T E R 10

Boundaries and the
Ethical Use of Power

Ms. Wicks: But Maria. I do care about you. I am worried you are
placing yourself in harm’s way. If it would be easier for you, I would
be willing to let you stay with me for a while.

C
ertainly Ms. Wicks is a very caring and concerned counselor. Ms.
Wicks has consistently demonstrated a real care and concern as well
as a desire to help. However, it appears that her level of concern and

her felt sense of urgency about the situation may be clouding her profes-
sional judgment. Knowing the boundaries of a professional relationship and
being able to operate within those boundaries while expressing professional
care and concern is not always an easy process. The power of the helping
relationship can be quite awesome and often times seductive. When such
power is not restricted by the boundaries of the professional relationship, it
invites misuse and abuse of the client.

OBJECTIVES ●

The chapter will introduce you to the concept of professional boundaries
and the conditions under which boundary crossing and violation may occur.
After reading this chapter, you should be able to do the following:

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242–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

• Describe what is meant by the concept of professional boundaries.
• Describe the difference between boundary violation and boundary

crossing.

• Explain how simple identification and transference can interfere with
the maintenance of professional boundaries.

• Describe what is meant by “dual” or “multiple” relationships.
• List questions for reflection that can guide a practitioner’s decisions

regarding the ethics of dual relationship.

• Explain why sexual intimacy with a client is clearly a boundary violation.

● SETTING AND MAINTAINING PROFESSIONAL BOUNDARIES

A professional relationship is a special entity. The professional relationship
is definable and does require unique dynamic and role definition. However,
the intensity of the emotions shared, the isolation provided, and the level of
intimacy sometimes experienced can challenge the boundaries of a profes-
sional relationship. Under these conditions, it is possible for ethical prob-
lems to occur as the helper blends professional role and relationship with
more personal involvement. The concepts of boundaries and boundary viola-
tions have received increased attention as a result of the increasing litigation
and ethics committee hearings related to violation of boundaries (Parsons &
Zhang, 2014). Setting and maintaining professional boundaries are essential
steps in preventing such personal involvement and the maintenance of an
ethical relationship. But the issues involved with the setting and maintain-
ing of professional boundaries is neither clear-cut nor black and white. For
example, the American Counseling Association’s Code of Ethics (2014) does
not strictly prohibit extending the nature of the boundaries between coun-
selor and client but rather directs its members to: “consider the risks and
benefits of extending current counseling relationships beyond conventional
parameters” (ACA, 2014, Principle A.6.b). While there are numerous terms
used to discuss the issue of boundaries and boundary extensions in profes-
sional practice, two terms, boundary violations and boundary crossing,
appear to dominate the literature.

Fasasi & Olowu (2013) suggest a distinction between boundary viola-
tions and boundary crossing. While both involve a counselor’s deviation from
strict adherence to a professional role, boundary violations typically result in
the exploitation of a client. Boundary violations, such as what occurs when
helpers become sexually involved with clients, are almost always harmful;
however, nonsexual boundary transgressions may be just as harmful.

When the practitioner’s needs are given primacy at the client’s expense,
it is unethical. Whether it is something as subtle as the rearrangement of

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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Chapter 10. Boundaries and the Ethical Use of Power –●–243

furniture or seating arrangement in order to bring the helper into closer physi-
cal proximity to an attractive client or a pause in the conversation that may be
inferred as having sexual innuendo, decisions by practitioners that are directed
to satisfy their professional needs at the expense of the client are violations of
professional boundaries and need to be avoided (see Case Illustration 10.1).

Case Illustration 10.1

Changing Seats: Moving Closer

Allison, a 32-year-old recent divorcee, has been working with
Dr. Manel for the past 5 weeks. Their sessions have been focusing on
Allison’s sense of grief and her anxiety about establishing or reestab-
lishing herself as a single woman.

For each of the past five sessions, Allison sat on the sofa with
Dr. Manel directly across from her in a large overstuffed chair. Allison
has, in each of the previous sessions, disclosed fears that she is not
attractive and would often break down in tears when she considered
the possibility of being alone. At these times, Dr. Manel would allow
Allison to cry and, when appropriate, would challenge her conclusions
that she would forever be alone.

Allison entered the current session more upset than she had been
in the previous three or four. Allison sat and shared with Dr. Manel that
she had just received divorce papers and that she wanted to die. Allison
began to sob and stated, “I can’t stand this! He doesn’t love me. No one
could ever love me. . . .”

At this point, Dr. Manel moved from his chair and took up a seat
on the couch next to Allison. As soon as he sat down, Allison flung
her arms about his neck, placing her head on his shoulder. Dr. Manel,
wiping her tears, stated, “I think you are lovable.”

In reviewing the case of Allison and Dr. Manel (Case Illustration 10.1),
one must wonder whether Dr. Manel’s change in seating and verbal com-
ment were meant simply to support a client in crisis or were in response to
his own interest in physical contact.

While such crossing of professional boundaries is clearly unethical, the
extension of boundaries in the form of boundary crossing is less clear in
its ethical implications. Boundary crossing places the helper outside of a
strict professional role; however, it does not occur with the intent of client
exploitation (Parsons & Zhang, 2014).

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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244–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

Boundary crossing occurs when the helper finds herself simultaneously
operating from both a professional and nonprofessional role. This might be
the case when a school counselor receives and accepts an invitation to attend
her client’s graduation party or even when unexpectedly she finds herself at a
social gathering with a client. In these situations, what was once a professional
helper-client relationship may now have moved to a casual social encounter.

It is important that as professional helpers we monitor the nature of
the relationship we have with our clients and take steps to ensure that the
boundaries are those that reflect our standard of ethics and clearly serve
to uphold the welfare and dignity of our clients (Kitchener & Anderson,
2011). Accepting gifts from clients, participating in social activities or events
provided by the client, engaging in investment activities or bartering profes-
sional services for goods or client service all blur the boundaries of a pro-
fessional practice. Throughout these situations, it is essential we reflect on
the question of “whose needs are being met?” Clearly, placing the personal
needs of the helper above that of the client invites unethical practice. Iden-
tifying whose needs are being met by the decisions and actions of the help-
ers will help to identify the potential for boundary violation. It is essential
that our primary goal is to do that which is in the best interest of the client
(Gutheil & Brodksy, 2008) and remember “that in choosing our profession
we made a decision to serve others and have our needs met by those whom
we do not we serve; we will fulfill our professional obligations” (Gottlieb &
Younggren, 2009, p. 570). All of our professional codes of ethics highlight
the need to attend to the issue of boundaries and the need to assure that
we protect against the creation of an exploitative relationship and eventual
harm to our clients (see Table 10.1.)

Table 10.1 Boundaries and Mixing of Multiple Relationships

Professional Ethical
Standards Statement on Multiple Relationships

American Counseling
Association (2014)

A.6.b. Extending counseling boundaries

Counselors consider the risks and benefits of extending current
counseling relationships beyond conventional parameters.
Examples include attending a client’s formal ceremony (e.g., a
wedding/commitment ceremony or graduation), purchasing a
service or product provided by a client (excepting unrestricted
bartering), and visiting a client’s ill family member in the hospital.
In extending these boundaries, counselors take appropriate
professional precautions such as informed consent, consultation,
supervision, and documentation to ensure that judgement is not
impaired and no harm occurs.

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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Chapter 10. Boundaries and the Ethical Use of Power –●–245

Professional Ethical
Standards Statement on Multiple Relationships

A.5.d. Friends or family members

Counselors are prohibited from engaging in counseling
relationships with friends or family members with whom they
have an inability to remain objective.

A.5.b.

Counselors are prohibited from engaging in counseling
relationships with persons with whom they have had a previous
sexual and/or romantic relationship.

A.5.e.

Counselors are prohibited from engaging in a personal virtual
relationship with individuals with whom they have a current
counseling relationship (e.g., through social and other media).

American Association
for Marriage and
Family Therapy
(2015)

1.3.

Marriage and family therapists are aware of their influential
positions with respect to clients, and they avoid exploiting the
trust and dependency of such persons. Therapists, therefore, make
every effort to avoid conditions and multiple relationships with
clients that could impair professional judgment or increase the risk
of exploitation. Such relationships include but are not limited to
business or close personal relationships with a client or the client’s
immediate family. When the risk of impairment or exploitation
exists due to conditions or multiple roles, therapists document the
appropriate precautions taken.

American
Psychological
Association (2010)

3.05 Multiple relationships

a. A multiple relationship occurs when a psychologists is in a
professional role with a person and (1) at the same time is in
another role with the same person, (2) at the same time is in
a relationship with a person closely associated with or related
to the person with whom the psychologist has the professional
relationship, or (3) promises to enter into another relationship in
the future with the person or a person closely associated with or
related to the person.

A psychologist refrains from entering into a multiple relationship if
the multiple relationship could reasonably be expected to impair
the psychologist, or otherwise risks exploitation or harm to the
person with whom the professional relationship exists.

Multiple relationships that would not reasonably be expected to
cause impairment or risk exploitation or harm are not unethical.

(Continued)

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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246–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

PROFESSIONAL OBJECTIVITY:
ESSENTIAL TO PROFESSIONAL BOUNDARIES

Professional Ethical
Standards Statement on Multiple Relationships

b. If psychologist finds that, due to unforeseen factors, a potentially
harmful multiple relationship has arisen, the psychologist takes
reasonable steps to resolve it with due regard for the best interests
of the affected person and maximal compliance with the Ethics
Code.

c. When psychologists are required by law, institutional policy,
or extraordinary circumstances to serve in more than one role in
judicial or administrative proceedings, at the outset they clarify
role expectations and the extent of confidentiality and thereafter
as changes occur.

Table 10.1 (Continued)

The effective, ethical helper places the concerns and needs of the client as
top priority. Placing the client’s concerns as a priority (i.e., altruism) rather
than the concerns of the helper (i.e., narcissism) requires the helper to
distinguish his or her personal issues and emotional needs from those pre-
sented by the client. The ability to be empathic, while emotionally objective,
may be difficult to maintain. However, if the helper’s objectivity becomes
compromised, the professional nature of the relationship may be threatened.
The ethical helper must be aware of the various situations that can compro-
mise professional objectivity and know when referral to another helper,
who can maintain objectivity, is indicated.

Professional objectivity can be compromised by a number of situations
(see Exercise 10.1). While some, such as simple identification and transfer-
ence, reflect a distortion of reality on the part of the helper, a more com-
mon form stems from the development of a dual relationship with the client
involving both a professional and personal tone. Each of these conditions is
discussed in some detail.

Simple Identification

A subtle form of loss of emotional objectivity is simple identification.
Simple identification occurs when the helper identifies himself or herself

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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Chapter 10. Boundaries and the Ethical Use of Power –●–247

with the client. It typically occurs when some element or characteristic of
the client or the client’s experience and story, causes the helper to relate to
the client’s experience as his or her own. Under these conditions, that helper
can begin to view the client as himself or herself (see Case Illustration 10.2)
and thus fails to discern the important difference between his or her experi-
ence and that of the client.

Exercise 10.1

Threats to Emotional Objectivity

Directions: After considering each of the following, share your
response with your colleagues or classmates in order to identify ways
of preventing such loss of objectivity.

1. Identify one person with whom you have a personal relationship
and discuss how that relationship could block your emotional
objectivity and thus interfere with you being an effective helper.

2. How might your own social roles (e.g., son, daughter, mother,
father, ex-boyfriend, girlfriend, struggling student, etc.) be the
source of interference and loss of objectivity when working with
some clients or specific types of problems?

3. Identify a number of themes or issues that arouse an emotional
response in you (e.g., themes of emotional dependency, victim-
ization, authority, power, etc.) and which might prove too close
to your own emotional experience for you to remain objective
while working with a client presenting similar concerns.

Case Illustration 10.2

Mr. Watkins: A Case of Simple Identification

Mr. Watkins was an elementary school counselor. One student with
whom he had special concern was Jamal. He felt Jamal needed his help
because the other fifth-grade boys “always teased Jamal and pushed
him and took his things.” According to Mr. Watkins, the other boys
were always mean to Jamal. Mr. Watkins was absolutely sure that Jamal

(Continued)

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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248–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

Mr. Watkins’s (Case Illustration 10.2) objectivity was certainly compro-
mised, and his pursuit of Jamal was a violation of his professional boundar-
ies. The problem was that Mr. Watkins was not “seeing” Jamal as he was
but rather was seeing himself in Jamal’s experience. Jamal looked like
Mr. Watkins. He was small and somewhat frail looking. He wore thick glasses
and appeared nonathletic. Because Mr. Watkins “identified” with Jamal on
the basis of physical similarity, his emotional objectivity was destroyed, and
he assumed that what happened to him as a fifth grader was most likely hap-
pening to Jamal.

Clearly, such loss of emotional objectivity needs to be identified and
confronted if one is to be an effective, ethical helper. Exercise 10.2 provides
you with an opportunity to anticipate the conditions under which you may
fall prey to simple identification.

was devastated by all of this. Well, the reality was that Jamal was fine.
In fact, Jamal went to Dr. Thomas, the director of counseling, and asked
that Mr. Watkins stop calling him down to the office. Jamal felt it was
embarrassing, and he didn’t understand why Mr. Watkins kept telling
him that he “could protect me from the bullies in school.” Apparently,
while the boys certainly did tease Jamal, he teased the other boys as
much as they teased him, and the fifth graders generally liked Jamal
and included him in their activities.

(Continued)

Exercise 10.2

Condition Eliciting Helper Identification

Directions: As noted, simple identification occurs when the helper
identifies himself or herself with the client. It typically occurs when
some element or characteristic of the client or the client’s experience
and story causes the helper to relate to the client’s experience as his or
her own. Below you will find a number of descriptors of client char-
acteristics or client issues. Place a check mark next to those character-
istics or elements with which you have some personal experience or
history. Next, identify how your identification with that element may
influence your objectivity.

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Chapter 10. Boundaries and the Ethical Use of Power –●–249

Element or
Characteristics

Helper Experience
or Characteristics

Impact on Helper
Objectivity

(Example): Client is a
freshman in college.
His father wants him
to be an engineer and
join his firm. The client
wants to be a music
major but is afraid to
upset his dad. He is
thinking that he could
double major, recog-
nizing that he does
like engineering and
may be able to use the
music as a performance
option.

Helper was a star
athlete in high
school. His father
has always prepped
him to play in col-
lege, even though
he did not want to
play in college.
The helper still
resents the fact that
he went to the col-
lege his dad wanted
him to and played
football there
though he truly did
not enjoy it.

The helper is
extremely con-
frontational with
the client. The
helper suggests
that compromis-
ing and doing a
double major is a
failure of mature
assertiveness. The
helper keeps push-
ing the client to
confront his father
and simply say
NO, it is my time
to define my life.

1. Client experiencing
a personal loss (via
divorce or death or
breakup)

2. A client who has
been teased for
being overweight,
underweight, an
early developer, or a
late developer

3. A client who is in an
unhappy relationship
or work situation

4. A client who is the
one in the family
to whom every one
turns when there is a
problem

(Continued)

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250–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

Element or
Characteristics

Helper Experience
or Characteristics

Impact on Helper
Objectivity

5. A person who is
currently having
sexual difficulties
(impotence, pre-
mature ejaculation,
low libido, limited
opportunity, etc.)

6. A person whose
beliefs (religious,
political, sexual)
have brought a sense
of isolation

7. Identify a significant
experience in your
life, and in the space
to the right identify
a type of client or
client condition
with which you may
identify.

(Continued)

Transference

A more complex distortion occurs with transference. In this case, the
helper forces the story of the client to fit some aspect of his or her own life.
This is a major distortion of reality and occurs below the conscious level of
the person distorting. It often results in the person, in this case the helper,
using the context of the helping relationship and presence of the client to
express feelings, beliefs, or desires that the helper has buried in his or her
unconscious and rightfully should address to some other significant person
in his or her life. The ability to be sensitive to the possibility of transference
is essential to effective, ethical helping.

While the loss of objectivity as a result of distorting the client’s reality,
as in the case with simple identification and transference, may be infrequent,
any helpers are at the risk of losing emotional objectivity if engaged in direct

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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Chapter 10. Boundaries and the Ethical Use of Power –●–251

personal involvement with clients. The possibility of engaging with the cli-
ent in a relationship outside of the boundaries of helping is a topic that has
received a lot of attention within the professional literature. The ethics of
such dual relationships with clients has been and continues to be debated. It
is clear, however, whichever side of the debate one finds himself or herself
on, dual relationships may serve as a condition in which one’s professional
objectivity can be compromised.

Dual Relationships: Crossing and/or
Mixing Boundaries

A dual relationship is one in which the helper has two (or more) overlap-
ping roles with the client. It is important to consider dual relationships and
to reflect on the possible impact they may have on the counseling relation-
ship (Exercise 10.3).

Loss of professional objectivity and boundary violations are possible any-
time a professional is engaged in multiple relationships with his or her cli-
ent. This may also occur when professional helpers are engaged in personal
friendships, family or business relationships, or social activities with their
clients (see Case Illustration 10.3).

Case Illustration 10.3

Tom and Elaine: Direct Personal Involvement

Tom is a master’s level counselor working in a college career center.
Elaine asked Tom to help her with a decision about joining the Peace
Corps. Elaine, who is also Tom’s girlfriend, explained that she really is
unsure if she should move away from their hometown to spend four years
in the Peace Corps or stay at home and continue in graduate school.

Tom suggested that Elaine employ an actuarial technique in which
she would generate all of the costs and benefits to be accrued to both
Elaine AND the significant people in her life if she stays or goes into
the Peace Corps. This was a technique Tom had found successful with
other clients. Typically, he would provide an initial example and then
ask clients to complete the process on their own as a “homework.”
He would then review their matrixes at the next session. With Elaine,
however, Tom suggested that they do it together. He felt that he could
help identify the possible benefits and costs to both Elaine AND,
certainly, to the others in her life.

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252–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

While Tom (Case Illustration 10.3) may truly want to assist Elaine in
making the best decision (for her), he may have difficulty keeping his own
strong desire to keep her close to him and at home out of the equation.
Thus, his suggestions may be aimed more at meeting his needs for a personal
relationship than at Elaine’s need to make the best vocational choice. Under
this situation, the dual nature of their relationship (i.e., love relationship and
helping relationship) is contaminating the helping process.

It appears that while all professional codes of conduct warn about the
risk of dual relationships (see Table 10.2), not all within the professions
are as clear-cut about the evils of dual relationships or if sanctions should
be applied. For example, Zur (2015) has suggested that engaging in limited
personal connections can be helpful as an integral part of a treatment plan.
For example, consider the value of giving a supportive hug to a grieving cli-
ent, accepting a small termination gift from a client whose culture dictates
such gift giving, or even flying in an airplane with a patient who suffers from
a fear of flying. Clearly, it is essential for the professional helper to monitor
all engagement in boundary modifications and extensions to ensure that the
needs of the clients are being served as the primary outcome.

Table 10.2 Codes Restricting Nonsexual Dual Relationships

Professional Ethical
Standards Statement Regarding Dual Relationship

American Psychological
Association (2010)

3.06. Conflict of interest

Psychologists refrain from taking on a professional role when
personal, scientific, professional, legal, financial, or other
interests or relationships could reasonably be expected to
(1) impair their objectivity, competence, or effectiveness in
performing their functions as psychologists or (2) expose the
person or organization with whom the professional relationship
exists to harm or exploitation.

National Association of
Social Workers (2008)

1.06. Conflicts of interest

c. Social workers should not engage in dual or multiple
relationships with clients or former clients in which there is a
risk of exploitation or potential harm to the client. In instances
when dual or multiple relationships are unavoidable, social
workers should take steps to protect clients and are responsible
for setting clear, appropriate, and culturally sensitive
boundaries. (Dual or multiple relationships occur when social
workers relate to clients in more than one relationship, whether
professional, social, or business. Dual or multiple relationships
can occur simultaneously or consecutively.)

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Chapter 10. Boundaries and the Ethical Use of Power –●–253

Professional Ethical
Standards Statement Regarding Dual Relationship

American Counseling
Association (2014)

A.6.e. Nonprofessional interactions or relationships

Counselors avoid entering into non-professional relationships
with former clients, their romantic partners, or their family
members when the interaction is potentially harmful to the
client. This applies to both in-person and electronic interactions
or relationships.

American Association
for Marriage and Family
Therapy (2015)

1.3.

Therapists, therefore, make every effort to avoid conditions
and multiple relationships with clients that could impair
professional judgment or increase the risk of exploitation.

While caution is advised, it is clear that there is no one directive to
which practitioners can turn for guidance in terms of boundary extension
and the engagement in dual relationships. Exercise 10.3 is provided to assist
you in gaining the perspective of your local professional community in
regard to the ethics of dual relationships.

Exercise 10.3

The Ethics of Dual Relationships

Directions: Using the questions listed below, assess the perception of
the professionals in your area in regard to the ethics of dual relation-
ships. If possible, contact a representative from each of the following
professions and share your findings with a colleague or classmate.
The professions include school counselor, marriage counselor, clinical
social worker, licensed psychologist, and psychiatrist.

Questions:

1. Have you ever had a professional helping relationship with a
friend? A relative? A close professional associate?

2. What are you feelings about the ethics or ethical challenges
confronting a professional helper when working with a friend,
relative, or colleague?

3. Would you ever engage in a business venture or investment with
an active client? (Continued)

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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254–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

Once again it is important to highlight that the position taken here is
that it is not the existence of duality that is the problem but the possibility
that such duality will invite exploitation of the client. As such, each case
should arouse concern and vigilance on the part of the ethical helper in
order to ensure that exploitation does not occur. It is incumbent on the
ethical practitioner to consult with colleagues, supervisors, and even the
research whenever experiencing boundary extension and to employ a con-
sistent model for ethical decision-making (see Chapter 7).

Kitchener and Anderson (2011), while echoing many of the steps found
in multiple ethical decision-making models, offers the following as funda-
mental considerations to be taken prior to engaging in any form of profes-
sional boundary extension. These considerations or direction include the
following:

• Taking a moment of reflection: Consider the benefits of such a bound-
ary extension. To what degree is the relationship improved and the
possibility of service to the client increased?

• Facts: What are the specific facts directing the desire to extend the
boundaries? Would these have directed the clinician to do the same
with other clients?

• Options: In exploring costs and benefits, what other options are avail-
able and potentially less costly?

• Include the client in the review of costs and benefits and the deci-
sions to be made.

• Identify the ethical codes and legal issues involved or implicated.
• Document the process and outcome of the decision-making.
• Review and reassess the outcome or impact of decisions, making

adjustments in service of ethical helping.

4. What are your feelings about professional helpers who engage in
sexual intimacies with a client while still in a helping relationship
with that client?

5. What would you do if you were aware that a professional helper,
in your locale, was engaged in a sexual relationship with a client?

6. What length of time, if any, needs to pass between the end of a
helping relationship and the freedom to date and become emo-
tionally and physically intimate with a previous client?

(Continued)

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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Chapter 10. Boundaries and the Ethical Use of Power –●–255

Sexual Intimacy: A Clear Violation of
Professional Boundaries

The depth of intimacy and the conditions surrounding the interaction
found in a helping relationship may stimulate feelings of attraction between
the helper and client. For helpers, acting on this attraction is a serious ethi-
cal violation. Sexual relationships of any kind are unethical in the helping
setting/context. All professional organizations are very clear about prohibi-
tion of sexual intimacy between a helper and a client (see Table 10.3).

The inappropriateness of a sexual relationship between helper and cli-
ent rests in the fact that the helping relationship is unbalanced in power and
dependency issues. Thus, the reciprocal natural characteristics of a healthy
intimate relationship are not possible. When sexual contact becomes part of
a therapeutic relationship, the expectation of trust that is fundamental to the
process of therapy is violated.

Table 10.3 Intimate Relationships With Clients

Professional Ethical
Standards Statement on Intimate Relationships

American Counseling
Association (2014)

A 5.a. Sexual and/or romantic relationships prohibited

Sexual and/or romantic counselor-client relationships with
current clients, their romantic partners, or their family members
are prohibited. This prohibition applies to both in person and
electronic interactions or relationships.

A.5.c. Sexual and/or romantic relationships with former clients

Sexual and/or romantic counselor client interactions or
relationships with former clients, their romantic partners, or their
family members are prohibited for a period of 5 years following the
last professional contact. This prohibition applies to both in person
and electronic interactions or relationships. Counselors, before
engaging in sexual and/or romantic interactions or relationships
with former clients, their romantic partners, or their family
members, demonstrate forethought and document (in written form)
whether the interaction or relationship can be viewed as exploitive
in any way and/or whether there is still potential to harm the
former client; in cases of potential exploitation and/or harm, the
counselor avoids entering into such an interaction or relationship.

(Continued)

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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256–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

Professional Ethical
Standards Statement on Intimate Relationships

American
Psychological
Association (2010)

3.08. Exploitative relationships

a. Psychologists do not exploit persons over whom they have
supervisory, evaluative, or other authority such as clients/patients,
students, supervisees, research participants, and employees.
(See also Standards 3.05 multiple relationships; 6.04 fees and
financial arrangements; 6.05 barter with clients/patients; 7.07
sexual intimacies with students and supervisees; 10.05 sexual
intimacies with current therapy clients/patients; 10.06 sexual
intimacies with relatives or significant others of current therapy
clients/patients; 10.07 therapy with former sexual partners; and
10.08 sexual intimacies with former therapy clients/patients.)

7.07 Sexual relationships with students and supervisees

Psychologists do not engage in sexual relationships with students
or supervisees who are in their department, agency, or training
center or over whom psychologists have or are likely to have
evaluative authority.

10.06. Sexual intimacies with relatives or significant others of
current therapy clients/patients

Psychologists do not engage in sexual intimacies with individuals
they know to be close relatives, guardians, or significant others
of current clients/patients. Psychologists do not terminate therapy
to circumvent this standard.

10.07. Therapy with former sexual partners Psychologists do not
accept as therapy clients/patients persons with whom they have
engaged in sexual intimacies.

10.08. Sexual intimacies with former therapy clients/patients

a. Psychologists do not engage in sexual intimacies with
former clients/patients for at least two years after cessation or
termination of therapy.

b. Psychologists do not engage in sexual intimacies with former
clients/patients even after two-year interval except in the most
unusual circumstances. Psychologists who engage in such
activity after the two years following cessation or termination of
therapy and of having no sexual contact with the former client/
patient bear the burden of demonstrating that there has been no
exploitation, in light of all relevant factors, including

Table 10.3 (Continued)

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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Chapter 10. Boundaries and the Ethical Use of Power –●–257

Professional Ethical
Standards Statement on Intimate Relationships

(1) the amount of time that has passed since therapy terminated;
(2) the nature, duration, and intensity of the therapy; (3) the
circumstances of termination; (4) the client’s/patient’s personal
history; (5) the client’s /patient’s current mental status; (6) the
likelihood of adverse impact on the client/patient; and (7) any
statements or actions made by the therapist during the course of
therapy suggesting or inviting the possibility of a posttermination
sexual or romantic relationship with the client/patient.

American Association
for Marriage
and Family Therapy
(2015)

1.4. Sexual intimacy with current clients or with known members
of the client’s family system is prohibited.

1.5. Sexual intimacy with former clients or with known members
of the client’s family system is prohibited.

National Association
of Social
Workers (2008)

1.09.a. Social workers should, under no circumstances, engage
in sexual activities or sexual contact with current clients,
whether such contact is consensual or forced.

In addition to barring intimate sexual contact within a helping context,
most codes of behavior also speak to the restriction of sexual behavior between
a helper and client after the helping relationship has ended. Some, for example,
the APA (2010), suggest that a period of 2 years pass before a personal relation-
ship may be entered, or the ACA (2014) suggests a period of 5 years.

While it should be obvious that sexual contact with one’s client is unethi-
cal, it is also important for all clinicians to be mindful of the danger that can
result from “innocent” comments about a client’s appearance, manner of dress,
or physique. The power of sexual or physical attraction of client to counselor
or counselor to client can be both subtle and compelling. When it comes to
a feeling of attraction to one’s client, it is essential that the helper engage in
consultation, supervision, or even personal therapy. It is possible that a simple
comment, such as “that is a wonderful looking blouse,” can lead down a slip-
pery slope to boundary violations (Sheperis, Henning, & Kocet, 2016).

LEGAL DECISIONS ●

Arguments for the unethical nature of dual relationships usually highlight
the fact that a helping relationship is one in which there is a power imbal-
ance and one in which the client may be extremely vulnerable (Norberg
v. Wynrib, 1992). The unethical nature of dual relationships reflects
the courts’ view that the helping relationships (i.e., physician-patient,

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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258–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

psychiatrist-patient, and social worker-client) are of a fiduciary nature
(McInerney v. MacDonald, 1992), fiduciary meaning that the professional
has a duty to act to the benefit of the other individual in any matters related
to an undertaking between them (Black, 1991). Since a fiduciary relationship
has been defined as occurring when an individual places his or her trust in a
party who has the potential to influence his or her actions (Black, 1991), it
could be reasonably argued that all professional helping relationships have
this fiduciary potential. The courts, however, have not made de facto rul-
ings on the fiduciary nature of each professional relationship. Rather, rulings
have suggested that it is the specific nature of each relationship that deter-
mines the existence of a fiduciary responsibility (Hodgkinson v. Simms,
1994; M. (K.) v. M. (H.), 1992; McInerney v. MacDonald, 1992).

If the fiduciary obligation exists, it could be argued that the practitioner
is obliged

• to act with good faith and loyalty toward a client (McInerney v.
MacDonald, 1992);

• to not abuse the power imbalance by exploiting the client (Norberg
v. Wynrib, 1992); and

• to act in the best interest of the client (Hodgkinson v. Simms, 1994;
M. (K.) v. M. (H.)., 1992).

Given the conditions of a fiduciary relationship, it is clear that any sexual
contact between a helper and a client is in violation of these conditions.
Such sexual contact is also subject to civil law as a tort (i.e., offenders may
be sued for malpractice), and some states have criminalized the offense.
At least 23 states criminalize sexual contact between psychotherapists and
clients, and nearly all of these states classify the violations as felony offenses.
Further, in these states, the power differential and possible vulnerability of
the client to influence makes consent by the client viewed as no defense.

● BEYOND PROFESSIONAL STANDARDS:
A PERSONAL MORAL RESPONSE

Sexual misconducts, while being one of the most serious ethical issues, con-
tinue to occur (Gottlieb & Younggren, 2009). Thus, while ethical standards
are in place that address professional boundaries and ethical use of power,
enactment of these standards within the client-helper relationship is less
than perfect.

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
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Chapter 10. Boundaries and the Ethical Use of Power –●–259

It is clear that more than simply having an awareness of the ethical
codes of conduct is needed. Practitioners need to embrace this standard as a
personal moral response. As with each of the ethical principles, respect and
valuing of the client and client well-being serve as the preventive base for
most ethical abuses. Keeping client needs as primary in the relationship can
prove invaluable for maintaining appropriate boundaries and use of power
within the helping relationship.

In addition to understanding codes of ethics governing the creation and
maintenance of professional boundaries, the ethical practitioner needs to con-
tinually appraise his or her own personal needs and to monitor how these may
impact the nature of his or her helping relationships. For example, in address-
ing sexual misconduct, Stake and Oliver (1991) recommended a multifaceted
approach highlighting the importance of sensitizing and training therapists to
their own sexuality and the power of the helping relationship.

In addition to increasing a clinician’s awareness of personal needs and
the power that comes from the helping relationship, it is also essential to
move from an ethics of avoiding misconduct to positive ethics (Handels-
man, Knapp, & Gottlieb, 2002). This directs the practitioner to that which
is truly reflecting their value of care and concern for the welfare of the cli-
ent. A focus on embracing such “positive ethics” brings a “shift of emphasis
from avoiding professional misconduct to a more balanced and integrative
approach that includes encouraging [the helper] to aspire to their highest
ethical potential” (Handelsman et al., p.731).

The need to be aware of self and relationships is essential in order to cre-
ate and maintain appropriate professional boundaries. Ethical practitioners
will be aware of their decisions to depart from what is typical and be able to
explain the therapeutic reasons for such departures. The question that needs
to be answered, especially at times of departure from typical or model pro-
cedures is “Whose need is being served?” It is this type of self-questioning,
if assimilated into the practitioner’s approach to all clients, that will help
move issues of boundaries and power from ethical guidelines to a personal,
moral response.

CONCLUDING CASE ILLUSTRATION ●

At the beginning of the chapter, we see Ms. Wicks expressing her concern
for Maria. The question one needs to ask is, is this level of concern and
type of behavior well within the boundaries of a professional counseling
relationship?

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260–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

As you read the continuation of the dialogue, ask yourself, whose
needs are being met? Further, after reading the presentation, use the
reflections to begin to conceptualize how you would respond in a situa-
tion such as this.

Ms.Wicks: But Maria, I do care about you. I am worried you are placing
yourself in harm’s way. If it would be easier for you, I would be
willing to let you stay with me for a while.

Maria: Stay with you?

Ms. Wicks: Well, I mean, sometimes it is easier to get away from a guy like
Carlos, when you can get out of the area.

Maria: I don’t need to get away from Carlos, I love him.

Ms. Wicks: Sometimes, Maria, we romanticize our relationships, and we
feel like it is love. It is just our way of justifying having sex with
somebody. I know . . . I almost ruined my life by quitting school
and running away with a high school sweetheart just because
I lost my virginity to him. It’s real easy to think you love someone
when it is only lust.

Maria: Well, I’m not sure what you are talking about. I love Carlos and
he loves me. I don’t need to run away from him.

Ms. Wicks: I know it seems like love, but trust me, Maria, if you could
step back and get away for just a little while, you would see it
differently.

Maria: Ms. Wicks . . . I like you, but . . . you are wrong here. Anyway
. . . how did we get talking about this? I thought we were
talking about you telling Ms. Armstrong about me having sex or
something?

Reflections

1. What is your feeling about Ms. Wicks’s invitation to come and live
with her for a while? Why?

2. Do you feel it is appropriate for Ms. Wicks to share her own high
school story of romance? Why? Why not?

3. Is Ms. Wicks exhibiting the effects of simple identification or simply
demonstrating her real personal understanding of Maria’s situation?

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Chapter 10. Boundaries and the Ethical Use of Power –●–261

COOPERATIVE LEARNING EXERCISE ●

As suggested within this chapter, while the need to create and maintain pro-
fessional boundaries is essential to an ethical helping relationship, boundary
violations do occur. Often boundaries are crossed and inappropriate helper
behavior is manifested as a result of the helper’s loss of emotional objectivity.

Part 1: Review each of the following scenarios and along with a classmate
or colleague, identify where the loss of emotional objectivity may exist and
how boundary violations may be manifested.

Helper 1: A marriage counselor currently going through her own very
painful divorce

Helper 2: A young, attractive school counselor working with senior high
school honors students

Helper 3: A drug and alcohol counselor who himself has been an addict
and who has recently returned to drinking

Part II: Interview three professional helpers, asking the following questions:

1. During your professional career, have you experienced any major life
crises (e.g., death of a loved one, loss of a job, divorce)?

2. (For those who have experienced such life crises) during that time,
what adjustments to your professional work did you make, if any?

3. (For those who have not experienced such a crisis) if you were to
experience one of these life crises, would you adjust your approach
to your professional work during the time of the crisis. If so, how and
why? If not, why not?

Share your findings with a colleague and discuss the implications of the
responses in light of the content of this chapter.

SUMMARY ●

• All professional codes of ethics attend to the issue of boundaries and
the need to assure nonexploitation of the client through boundary
crossing and the mixing of multiple relationships.

• All boundary crossings (i.e., departure from commonly accepted pro-
fessional roles and practices) can become problematic and need to be

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262–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

avoided. Any boundary violation in which the practitioner’s needs are
given primacy at the client’s expense is unethical.

• The effective, ethical helper places the concerns and needs of the
client as top priority. Placing the client’s concerns as a priority (i.e.,
altruism) rather than the concerns of the helper (i.e., narcissism)
requires the helper to distinguish his or her personal issues and emo-
tional needs from those presented by the client.

• Professional objectivity can be compromised by a number of situa-
tions. While some, such as simple identification and transferences,
reflect a distortion of reality on the part of the helper, a more com-
mon form stems from the development of a dual relationship with the
client, involving both a professional and personal tone.

• A dual relationship is one in which the helper has two (or more) overlap-
ping roles with the client. While all professional codes of conduct warn
about the risk of dual relationships, not all codes are as clear-cut about the
evils of dual relationships or about the sanctions that should be applied.

• It is not the existence of duality that is the problem but the possibility
that such duality will invite exploitation of the client. As such, each
case should arouse concern and vigilance on the part of the ethical
helper in order to ensure that exploitation does not occur.

• Sexual relationships of any kind are unethical in the helping setting/
context. All professional organizations are very clear about prohibi-
tion of sexual intimacy between a helper and a client.

• The inappropriateness of a sexual relationship between helper and
client rests in the fact that the helping relationship is unbalanced in
power and dependency issues. As such, the reciprocal nature of a
healthy intimate relationship is not possible. When sexual contact
becomes part of a therapeutic relationship, the expectation of trust
that is fundamental to the process of therapy is violated.

• The unethical nature of dual relationships reflects the courts’ view
that the helping relationships (i.e., physician-patient, psychiatrist-
patient, and social worker-client) are of a fiduciary nature, meaning
that the professional has a duty to act to the benefit of the other indi-
vidual in any matters related to an undertaking between them.

• If the fiduciary obligation exists, it could be argued that the practi-
tioner is obliged to act in the best interest of and in good faith and
with loyalty toward the client and not abuse the power imbalance by
exploiting the client.

• Keeping client needs as primary in the relationship can prove invalu-
able for maintaining appropriate boundaries and use of power within
the helping relationship.

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a>
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Chapter 10. Boundaries and the Ethical Use of Power –●–263

• The need to be aware of self and relationships is essential in order
to create and maintain appropriate professional boundaries. Ethical
practitioners will be aware of their decisions to depart from what is
typical and be able to explain the therapeutic reasons for such depar-
ture. The question that needs to be answered, especially at times of
departure from typical or model procedures is, whose need is being
served?

IMPORTANT TERMS ●

altruism multiple relationship

boundaries narcissism

boundary crossing professional objectivity

boundary violations professional relationship

dual relationships sexual identification

exploitation sexual intimacy

fiduciary obligation transference

fiduciary relationship

ADDITIONAL RESOURCES ●

Print

Calmes, S. A., Piazza, N. J., & Laux, J. M. (2013). The use of touch in counseling: An
ethical decision-making model. Counseling & Values, 58(1), 59–68.

Herlihy, B., & Corey, G. (2014). Boundary issues in counseling: Multiple roles and
Responsibilities. Alexandria, VA: American Counseling Association.

Pope, K. S., & Vasquez, M. J. (2005). How to survive and thrive as a therapist:
Information, ideas, and resources for psychologists in practice. Washington,
DC: American Psychological Association.

Syme, G. (2003). Dual relationships in counselling and psychotherapy: Exploring
the limits. Thousand Oaks, CA: Sage.

Zur, O. (2007). Boundaries in psychotherapy: Ethical and clinical explorations.
Washington, DC: American Psychological Association.

Zur, O. (2015). Therapeutic boundaries and dual relationships in psychotherapy.
Retrieved from http://www.zurinstitute.com/boundariesbrochure.pdf

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a>
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264–●–ETHICAL PRACTICE IN THE HUMAN SERVICES

Web-Based

Bleiberg, J. R., & Baron, J. (2004). Entanglement in dual relationships in a university
counseling center. Journal of College Student Psychotherapy, 19(1), 21–34.

Pope, K. S. (n.d.). Dual relationships, multiple relationships, & boundary decisions.
Retrieved from http://www.kspope.com/dual/

Pope, K. S., & Keith-Spiegel, P. (n.d.). A practical approach to boundaries in psycho-
therapy: Making decisions, bypassing blunders, and mending fences. Retrieved
from http://kspope.com/ethics/boundary.php

Reamer, F. G. (2003). Boundary issues in social work: Managing dual relationships.
Social Work, 48(1), 121–133.

● REFERENCES

American Association for Marriage and Family Therapy. (2015). Code of ethics.
Retrieved from http://www.aamft.org/iMIS15/AAMFT/Content/Legal_Ethics/
Code_of_Ethics.aspx

American Counseling Association. (2014). Code of ethics. Retrieved from http://www
.counseling.org/resources/aca-code-of-ethics.pdf

American Psychological Association. (2010). Ethical principles of psychologists and
code of conduct. Retrieved from http://www.apa.org/ethics/code/principles.pdf

Black, H. C. (1991). Black’s law dictionary (Abridged, 6th ed.). St. Paul, MN: West
Publishing.

Fasasi, M. I., & Olowu, A. A. (2013). Boundary transgressions: An issue in psycho-
therapeutic encounter. IFE Psychologia, 21(3S), 139–151.

Gottlieb, M. C., & Younggren, J. N. (2009). Is there a slippery slope? Considerations
regarding multiple relationships and risk management. Professional Psychology:
Research and Practice, 40(6), 564–571.

Gutheil, T., & Brodsky, A. (2008). Preventing boundary violations in clinical practice.
New York: Guilford.

Handelsman, M. M., Knapp, S. J., & Gottlieb, M. C. (2002). Positive ethics. In C. R.
Snyder & S. J. Lopez (Eds.), Handbook of positive psychology (pp. 731–744).
New York: Oxford University Press.

Hodgkinson v. Simms, 3 S.C.R. 377 (1994).
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and teaching in psychology and counseling (2nd ed.). New York: Routledge.
McInerney v. MacDonald, 2 S.C.R. 138 (1992).
M. (K.) v. M. (H.), 96 DLR (4th) 289, (1992).
National Association of Social Workers. (2008). Code of ethics. Retrieved from http://

socialworkers.org/pubs/code/default.asp
Norberg v. Wynrib, 2 S.C.R. 226 (1992).
Parsons, R. D., & Zhang, N. (2014). Becoming a skilled counselor. Thousand Oaks,

CA: Sage.

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a>
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Chapter 10. Boundaries and the Ethical Use of Power –●–265

Sheperis, D. S., Henning, S. L., & Kocet, M. M. (2016). Ethical decision making for
the 21st century counselor. Thousand Oaks, CA: Sage.

Stake, J. E., & Oliver, J. (1991). Sexual contact and touching between therapist and
client. A survey of psychologists’ attitudes and behaviors. Professional Psychol-
ogy: Research and Practice, 22(4), 297–307.

Zur, O. (2015). Therapeutic boundaries and dual relationships in psychotherapy.
Retrieved from http://www.zurinstitute.com/boundariesbrochure.pdf

Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a>
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Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a
onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a>
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