The Primary Therapeutic Relationship Comes First ANN L. TILMAN, EDD, SB-RPT


    accepted as being central to change in play therapy. Stewart and  change in play therapy though shared goals, trust and security, and a meaningful connection with the play therapist. Boundaries         therapist, child, and parent alike. They provide a safe,


predictable space for the child to change and grow, leading to a sense of security. Unclear boundaries, roles, and responsibilities impact the power differential within the therapeutic relationship, allowing opportunities for  therapy with the play therapist who is seeing their child, the resulting multiple relationships can cause a disruption to the therapeutic alliance.


Risks and Relationships Engaging in an ethical decision-making process includes a review of potential risks. A risk for the play therapist providing individual therapy to the parent is ambiguity about who the client is, resulting in a loyalty bind. Diverging obligations may cause loyalty confusion, conflict of interest,          Different expectations may arise from different roles, such as parent  may be incompatible when roles overlap. Various play therapy approaches      therapy, psychoeducation). Ultimately, the focus must remain on the child or child-parent relationship, rather than individual therapy with the parent.


Primary Responsibility and Dual/Multiple Relationships A review of the ethical codes associated with play therapists’ professional


Scope of Practice Clinicians must carefully consider their scope of practice, especially if the clinician has been primarily treating children and does not have          align, and give both the parent and child the level of service and care that each need.


Boundaries           communicate the nature of the therapy relationship along with  consultation, the therapist may reflect on the following questions: 1. How has the clinician managed boundaries thus far in the therapeutic relationship?


2. How will boundaries be managed if the clinician becomes the primary therapist to both the child and parent?


3. Does the clinician feel any pressure to take on the parent as a client?  clinician is being drawn into, such as enmeshment, triangulation, etc.?


Finally, the play therapist should consider how they might defend their decision if brought before a professional licensing board. Notes from supervision or consultation, along with documentation of the ethical decision-making process, using an ethical decision-making framework (e.g., Forest-Miller & Davis, 2016), would be essential to their defense. A decision to see more than one individual in a family system can have impacts on the child, parent, and the clinician and may or may not be sanctioned by state laws. It is essential to consider the ethical issues that arise when such situations are  decision – to the client(s) and to the clinician – prior to proceeding.


www.a4pt.org | December 2021 | PLAYTHERAPY | 17


COUNTER POINT


                       consistent message across ethical codes that the primary responsibility       the child, the play therapist should honor that primary relationship.


Through their codes, professional organizations all address the issues of dual/multiple relationships, establishing boundaries and roles, inherent risks, clearly emphasizing avoiding these types of relationships when possible, and only navigating them when unavoidable (e.g., AAMFT, 2015,      another mental health professional helps avoid ethical conflict. In rural areas and where in-person mental health services aren’t available, tele- mental health services usually are. The play therapy relationship should be preserved as APT states, “The therapist understands that the minor is their client and represents the minor client, not the legal guardian” (APT, 


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40