_____________________________________________________________ Managing Professional Boundaries
• Running into a client at the store or a public gathering. • Temporarily reducing the session fee for a client who just lost their job. All of these situations deviate from traditional practice but are not necessarily harmful to the client. Not all boundary crossings lead to boundary violations, and some boundary flexibility allows for a response to an individual client’s needs at that time. A boundary violation is a more serious infraction. It is a devia- tion from practice which is harmful or exploitative of the client (Appel, 2023). A boundary violation moves the therapist out of the professional role; it tends to benefit the clinician more than the client; there is risk of harm to the client; it is often exploitative; and it violates professional ethical standards. When a boundary violation has occurred, the professional has engaged in a cognitive decision-making process that allowed a potentially harmful behavior to occur. This is not necessar- ily intentionally malicious behavior; it could have occurred from the professional being selfish, uninformed, or impaired. Nonetheless, the potential for causing harm to the client is great. Some potential consequences for the client can include the client prematurely terminating services, emotional distress, feelings of shame or anger, guilt or self-blame, confusion, or mistrust. Consider the following boundary violations and how they may impact the client and therapist: • Engaging in a sexually provocative conversation with the client • Discussing a client’s confidential information with a group of friends at a social party • Extensive therapist self-disclosure about the therapist’s past abuse history • The therapist pressuring the client to babysit the therapist’s child Professionals tend to believe that they instinctively know where a professional boundary lies. However, the professional’s understanding of a boundary may be very different from the client’s understanding. A good number of licensing board com- plaints relate to client-perceived boundary issues; however, it is difficult to ascertain the actual frequency of boundary crossings or violations. Magiste (2020) examined the prevalence of ethics violation complaints to state social work licensing boards from 1985 through 2013. This review of literature found that the actual occurrence of professional ethics violations was low, at a rate of 0.05% of the total licensed population over 28 years of data. Although failure to comply with continuing education audit requirements was the largest group of violations, this was followed closely by nonsexual boundary violations, specifically, engaging in dual relationships.
Self-Assessment Quiz Question 1. Which ethical principle states that a clinician has a responsibility to be fair, impartial, and treat
people equally? A) Beneficence
B) Nonmaleficence C) Integrity/fidelity D) Autonomy/justice
THE CONCEPT OF BOUNDARIES The concept of boundaries in the therapeutic relationship has received increasing attention over the years and is addressed in most of the laws, regulations, and ethics codes of the various professions. However, these tend to focus on the more extreme violations with less attention being paid to the subtle and less obvious boundary issues that can cause difficulty for clinicians. Boundaries in professional relationships have been defined in many ways. According to the American Psychological Associa- tion, (APA 2023) boundary issues are “Ethical issues relating to the proper limits of a professional relationship between a provider of services and his or her patient or client, such that the trust and vulnerability of the latter are not abused.” Essentially, boundaries are the line between professional and personal. The fundamental purpose of boundaries in therapy is to create and maintain clear expectations for the client in order to provide the client protection from harm. When boundaries are not respected, there is risk of the therapist starting to work in their own best interest, which could lead to exploitation or harm to their client. Despite the importance of boundary knowledge, Chen and colleagues (2018) point out that educa- tion about boundaries in training and education programs tends to take on an abstract, theoretical quality and does not address the day-to-day dilemmas that most practitioners face. The terms “boundary crossings” and “boundary violations” are often used interchangeably, but the literature strives to separate the terms. Boundary crossings refers to any deviation from traditional practice which are harmless to the client and may also at times be therapeutic (Appel, 2023). It refers to situations where a boundary is crossed in order to meet therapeutic goals, and it does not harm the client or dam- age the therapeutic relationship. Boundary crossings are not uncommon in day-to-day practice. The following are examples of common boundary crossings: • Limited self-disclosure by the therapist to help establish rapport or normalize the client’s behavior. • Extending the length of a session one time for a client in distress. • Taking nonemergency phone calls between sessions. • Accepting a minor gift from a client.
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