Saturday, 1 October 2016

Ethics and Boundaries Regarding Prisoner-Clients

I am a co-facilitator (pro bono, unlicensed) for a men’s DV group (court-mandated) at a non-profit. The leader is a therapist who also has a private practice. In group one of the men mentioned fear of losing his probation for something he didn’t do and being imprisoned for years at an upcoming hearing. He didn’t return to the group after the hearing. She discovered he indeed had been jailed with another hearing soon to determine whether he will be imprisoned. He’s made enormous progress, despite a terrible childhood and adverse family dynamics, he has a good heart and reaches out to other group members, attends a drug-tested substance abusers group three times a week, and has focused on becoming a father again to his children (they were not the recipients of his abuse). But he’s also expressed suicidal thoughts in the past in the context of never wanting to go back to prison, and he’s become worn out and depressed in dealing with The System (frequent court hearings, probation officers, in-laws, etc. – you can imagine), and we’re deeply concerned about his mental health. He’s received no visitors. LA County is under a DOJ consent agreement to improve its mental health resources, but there have been numerous suicides nonetheless. The therapist is considering visiting the client in jail to check on his health and give him moral support, to let him know someone cares. But she and the non-profit center are conflicted about ethics and boundaries and dual relationships – she says this issue was never discussed in school or workshops, and the non-profit doesn’t even have a policy because this issue has never arisen before. I think it’s because the people setting boundaries aren’t the kind of people who go to jail very often. A large proportion of the country’s 2 million prisoners have some degree of mental illness and get almost no care. He hasn’t called — he’s expressed a sense of unworthiness that might keep him from calling. I don’t think this is the usual ethics and boundaries issue, and I think in these circumstances the benefit for man’s mental health and maybe even his life far outweighs the boundary risk. What do you think? It seems a Catch-22, but shouldn’t be, given the problem of mental illness in prisons.

 

A: Thank you for your thought-provoking question. First, let me say how admirable it is to hear of your thoughtfulness for this man. I deeply admire your genuine concern for his well-being. The gray and beige area of this type of concern could be argued for both sides. I don’t think it is an easy answer — but if I were consulting I’d ask the administrators in the agency if it would be reasonable for you, the therapist, or you and the therapist together to write a letter letting him know you are there for him if he wants to reach out. He may have shame about his situation and not want visits, but a letter giving him permission to make a connection may be helpful. Reaching out in this way may be an acceptable way to show your concern.

Wishing you patience and peace,
Dr. DanProof Positive Blog @ PsychCentral



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