1.  Is coaching a teenager-patient on anxiety-related issues in context of a skate boarding lessons
definitively a dual relationship?
2.  What if the coaching is time-limited, informed consent is given, and this activity is viewed as the
exception rather than the rule?  (“Time-limited” means between one and six sessions, depending
on his response to treatment.)
3.  Can time-limited skateboard coaching be incorporated as part of an in-vivo anxiety reduction
technique and billed as therapy services?
4.  Would Dr. Earthski’s malpractice insurance likely cover this activity?
5.  What would happen if the teen-patient injured himself as part of coaching?
6.  Dr. Earthski asks about the use of self-disclosure.  What feedback might you give to Dr. Earthski
about what he disclosed about himself?

7.  Given everything you know about the case, what is/are the final recommendation(s)

ANSWER

Navigating Dual Relationships and Therapeutic Boundaries: A Comprehensive Analysis

In the realm of therapeutic practice, the ethical considerations surrounding dual relationships, informed consent, and the integration of alternative interventions can be complex and multifaceted. Dr. Earthski’s involvement in coaching a teenage patient on anxiety-related issues in the context of skateboarding lessons raises several ethical, legal, and clinical questions. This essay addresses each question in detail, offering insights and recommendations for Dr. Earthski’s professional conduct.

Dual Relationship Consideration: Coaching a teenager-patient on anxiety-related issues while providing skateboarding lessons indeed raises concerns about dual relationships. A dual relationship occurs when a therapist takes on multiple roles with a client, potentially compromising objectivity and therapeutic boundaries.

Time-Limited Coaching and Informed Consent: If the coaching is time-limited, informed consent is obtained, and the activity is treated as an exception rather than the norm, the dual relationship’s ethical implications may be mitigated to an extent. However, it is essential to carefully assess potential conflicts of interest and whether such an arrangement genuinely serves the patient’s therapeutic needs.

Incorporating Coaching as Therapy Services: Incorporating time-limited skateboard coaching as part of in-vivo anxiety reduction techniques can be ethically permissible if done within the framework of a well-structured treatment plan. However, billing it as therapy services could raise legal and insurance-related considerations. Consultation with legal and ethical experts is advised to ensure compliance.

Malpractice Insurance Coverage: Dr. Earthski’s malpractice insurance coverage may or may not encompass this activity, depending on the terms of the policy. It is crucial to review the policy and, if needed, consult with the insurance provider to clarify whether such activities fall within the coverage scope.

Injury and Liability: In the event that the teen-patient sustains an injury during coaching, potential legal and ethical liabilities may arise. Dr. Earthski should ensure that the activity is conducted in a safe environment, with proper supervision and risk management measures in place.

Self-Disclosure and Professional Boundaries: Dr. Earthski’s self-disclosure about himself raises concerns about crossing therapeutic boundaries. While self-disclosure can foster rapport, it must be carefully considered to prevent overshadowing the patient’s needs and maintaining the focus on their therapeutic journey.

Final Recommendations

Clinical Supervision: Dr. Earthski should seek clinical supervision or consultation to evaluate the appropriateness of incorporating skateboarding coaching within the therapeutic framework.

Transparent Communication: Transparently communicate to the teenage patient and their guardians about the nature, purpose, and potential benefits and risks of the coaching intervention.

Thorough Documentation: Document the rationale, goals, duration, and outcomes of the skateboarding coaching activity in the patient’s treatment plan to maintain transparency and accountability.

Risk Assessment: Conduct a thorough risk assessment to ensure the safety of the patient during the coaching sessions and take necessary precautions to prevent injuries.

Ethical and Legal Guidance: Seek advice from legal and ethical experts to ensure that the coaching activity aligns with professional standards, legal requirements, and insurance coverage.

In navigating this complex scenario, Dr. Earthski should prioritize the well-being, autonomy, and therapeutic progress of the teenage patient while adhering to ethical principles and legal obligations that guide his professional practice.