Touro University Worldwide (1651 words) Essay

Touro University Worldwide
Professional Ethics
Fall 2017-1
September 24, 2017
Tamerla Glenn
Dr. Michael Hamlin

This paper analyses social, ethical and legal issues within a complaint initiated by the NSW
Health Care Complaints Commission (HCCC) against a psychologist, Steven Kreft (HCCC v
Kreft, 2011). The HCCC investigated a complaint by a client of Kreft of personal and sexual
disclosures, as well as unprofessional treatment in the solicitation of a photograph of the client in
which the client was dressed in underwear. Kreft’s actions are assessed in light of professional
and ethical standards as well as potential breaches of the law.

Steven Kreft, was an experienced psychologist narrowly specializing in the treatment of
men with anxiety conditions using cognitive-behavioral therapy (HCCC v Kreft, 2011). The
client, a 19 -year-old married women, was referred to Kreft because of anxiety and possibly
panic attacks, but during the initial stages of counseling, she raised relationship problems, her
appearance and sexual needs and practices with him and these became the focus of their sessions.
Kreft conveyed to the client that he was not experienced or skilled in the treatment of
relationship problems or sexual disorders, however, the client stated that she wished to continue
working with him and he did not insist on referring her elsewhere.

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The client ultimately accused Kreft of failing to observe proper professional boundaries and
engaging in inappropriate discussions of a personal nature in which he:
Complimented her on her appearance referring to her petite size, short height and thin
build, and likened her to his girlfriend;
Asked the client to comment on his physical appearance;
Disclosed details of his personal life including the number of sexual partners he had, that his girlfriend would share a bed with other girlfriends when they slept over, that he had been in love numerous times, and that he had thought about homosexuality during his youth (HCCC v Kreft, 2011).

In addition, Kreft was accused of failing to follow or observe appropriate therapeutic practice
and/or failing to observe proper professional boundaries when he asked the client for
photographs for a study in which people would rate the client’s appearance. One of these
photographs pictured the client dressed in underwear. Kreft copied these photographs onto his
computer for later presentation to unnamed others. This exercise was not recorded in the client’s
clinical notes (HCCC v Kreft, 2011). The HCCC invested the client’s complaints and took
disciplinary action against him.

There are numerous social, ethical and legal issues in this case. Although Kreft was in fact a
psychologist, for the purpose of this paper, his conduct will be assessed against the Australian
Counseling Association’s Code of Ethics and Practice (2012). The paper will explore the power
imbalance between Kreft and his client, the effect of his behavior on the therapeutic relationship
and whether Kreft’s behavior might have breached sexual harassment laws.

Ethical and legal guidelines exist to offer protection to people who may experience harm as a
result of the actions of another person. According to Welfel (2013, p.3), professional ethics in
counseling encompasses five dimensions of behavior including having sufficient knowledge,
skill and judgement; respecting the client’s human dignity and freedom; using a counselor’s
inherent power responsibly; and, acting to promote public confidence in the counseling
profession. This provides a useful framework for assessing Kreft’s conduct in this case.

Beginning with Kreft’s expertise, Kreft usually used a strict cognitive-behavioral protocol
for the management of anxiety and panic disorders. Kreft is described by his own treating
psychiatrist as a skilled practitioner in a narrow field, having been trained to think rationally and
logically. Kreft’s practice “involved administering protocols, carrying out logic-based
interventions and requires his patients to occupy a mindset where they share a common objective
and commitment to the treatment and its proposed outcome” (HCCC v Kreft, 2011 at 227).
Although referred to Kreft because of his relevant expertise, the treatment interaction became
sexualized when the client began talking about her sexual experiences and practices. There was
further exploration of her concerns about her personal appearance, low self-esteem, need for
validation by men via her sexual activities and description of her specific sexual behavior. Here,
Kreft was out of his professional depth. Specifically, on this matter, the Australian Counseling
Association’s (ACA) Code of Ethics and Practice states that counselors must “endeavor to make
suitable referral where competent service cannot be provided” (p.3) and “undertake regular
supervision and debriefing to develop skills, monitor performance and sustain professional
accountability’ (p.3).

Although Kreft recognized that the client’s relationship and sexual issues were beyond his
expertise and conveyed as much to the client, he could have insisted on referral, despite the
client’s preference for continued sessions with him. The ACA further states that competence
includes being able to recognize when it is appropriate to refer a client elsewhere (p.12). The
rationale for this professional expectation is that counselors are required to “take all reasonable
steps to ensure that the client does not suffer physical, emotional or psychological harm during
counseling sessions” (p.4).

Sexualization of the therapeutic relationship can be harmful to clients, and in this case, it is
difficult to see how it served the client. According to the ACA of Ethics and Practice, “the
helping relationship constitutes the effective and appropriate use of helper’s skills that are the
benefit and safety of the client in his or her circumstances” (2012, p3), and “counselors must take
all reasonable steps to ensure that the client does not suffer physical, emotional or psychological
harm during counseling session” (2012, p.4).

In relation to the disclosures, for whose benefit, were they? It is unclear, what led Kreft to
make sexualized self-disclosures and what purpose he thought they served. Perhaps it was a
response to the client’s exploration of her relationships and sexual activities. Such client self-
disclosure can sexualize the therapeutic relationship (Gurtheil & Brodsky, 2011, p.11) state that
in cases of sexual misconduct, “a key turning point often occurs when the relationship shifts
from a therapeutic exchange to one of sharing personal confidences and feelings” (p.114).

They further state that even therapists whose practice deliberately open self-disclosure, it is
rarely useful and usually burdensome for clients to hear details of the therapist’s emotional,
sexual, personal or family life. “Such disclosures, especially when they involve sexual feelings,
are nearly always considered boundary violations” (p.115). It seems that Kreft may have been
meeting some personal need by making the disclosures. Without having observed the interaction,
it is difficult to judge, however, perhaps in an attempt to normalize the client’s experience or
keep her engaged, Kreft seems to also be almost boasting of his own sexual prowess. This
amounts to an exploitation of the client for his own needs. The APA states that, “counselors must
not exploit their clients financially, sexually, emotionally or in any other way (pp.4-5). If poorly
handled, the prow imbalance inherent in the therapeutic relationship can lead to exploitation of
clients (Barnett, Lazarus, Vasquez, Moorehead-Slaughter & Johnson, 2007.p.402). A young
female client, is less likely to challenge the appropriateness of such comments. In addition to the
sexualized disclosures, Kreft devised an exercise based on his narrow focus on CBT, which he
believed would help the client. He requested and obtained a photo of his client wearing bra and
underpants for the purpose of an exercise aimed at “challenging” the client’s maladaptive or
negative beliefs about her appearance. The photo was to be shown to a number of unnamed
people in order for them to rate her appearance, Kreft claimed in his testimony that he created the
exercise based on his expertise and training. He did not state that he researched current effective
practice or discussed the client’s needs in supervision. It would seem prudent to educate oneself
about unfamiliar field of practice or client.

In conclusion, it seems that Steven Kreft’s behavior in this case fell far short of recognizing
ethical, legal and social expectations, He took on a client with issues outside his narrow expertise
and attempted to work with her in relation to the highly sexualized disclosures she made her
relationship with men, Kreft’s own highly sexualized personal disclosures were unethical
according to professional guidelines and potentially unlawful, under sexual harassment laws.
Kreft’s attempts to help the client change her negative beliefs about her body were devised
without reference to existing knowledge in the treatment of such problems and again become
sexualized when Kreft chose a photo of the client dressed only in underwear. Ultimately, Kreft
was required to update his training, engage in regular supervision, and undergo a suspension of
practice for six months. Kreft’s case provides a number of warnings for other practitioners about
the dangers of a narrow knowledge and experience base, as well as the importance of
understanding the various dimensions of therapeutic relationships/ Counselors would do well to
have a sound understanding of ethical boundaries and how they might appropriately response to
a client’s disclosures of sexual behavior. Having regular supervision is crucial for assisting
counselors in all of these areas.

Australian Counselling Association. (2012). Code of ethics and practice. QLD: Author.

Barnett, J., Lazarus, A., Vasquez, M., Moorehead-Slaughter, O., ; Johnson, W. (2007). Boundary issues and multiple relationships: Fantasy and reality. Professional Psychology: Research and Practice, 38(4), 401-410.

Gurtheil, T. G. ; Brodsky, A. (2011). Preventing boundary violations in clinical practice.

London: Guilford Press.

HCCC v Kreft (No. 1) (2011) NSWPST 2.

HCCC v Kreft (No. 2) (2012) NSWPST 1.

Pope, K. S. ; Vasquez, M. J. (2011). Ethics in psychotherapy and counselling: A practical guide. New Jersey: John Wiley and Sons.

Welfel, E. R. (2013). Ethics in counseling and psychotherapy. (5th ed.). Belmont, CA:


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