● The client reminds the therapist of someone significant in their life, and the counselor feels a sense of familial comfort with them. ● The counselor feels attraction toward the client. ● The counselor self-identifies with the client, perceiving some of their own traits and qualities in the client. Self-Assessment Quiz Question #2 Examples of boundary crossings include all of the following except: a. Extending the session one time b. Having a sexually provocative conversation with the client c. Accepting a small, inexpensive gift from the client d. Running into the client at church
It is apparent that in order to provide ethical care to clients, it is crucial for the clinician to understand the definition of boundaries. They must recognize boundary situations, differentiate a boundary crossing from a boundary violation, and have a knowledge base for evaluating and navigating those situations. Corey and Corey (2021) list several signs that the counselor must pay attention to as they may be early warning signs that therapist objectivity may be an issue and a boundary crossing may occur: ● The counselor finds themself going out of their way to be helpful to the client, to the extent that the client becomes more dependent. ● The counselor is experiencing negative feelings toward the client, for example, they feel relieved when the client cancels a session.
ESTABLISHING BOUNDARIES IN THERAPY
Healthcare services are value-laden professions in which the clinician brings their own personal values, beliefs, and viewpoints to the session. These have the potential to cloud ethical decision making. Recognizing one’s own viewpoints does not eliminate ethical bias but may at least help to mitigate their impact on ethical decision making. All professional ethics codes remind providers that they should not let their personal issues interfere with their professional judgement or jeopardize their responsibility to work in the best interests of their clients. The NBCC Code of Ethics (2015), for example, specifically states that counselors avoid imposing their personal values on those who receive their professional services (Principle 17). Establishing clear boundaries at the onset of therapy helps to create a set of ground rules which guide the course of therapy. This serves to build a sense of trust and safety for the client in the therapeutic environment. While therapists tend to keep their code of ethics in mind when establishing boundaries in therapy, they may not have direct and explicit conversations with their clients about those boundaries. That discussion is crucial, however, to avoid any confusion or misunderstanding during the course of therapy. An explicit discussion about boundaries, roles, and responsibilities at the start of therapy can help prevent or resolve problems later. Celestine (2021) reviews six areas related to boundaries to be mindful of when entering into a therapeutic relationship with a client. 1. Use contracts and informed consent. This should include discussion about the risks and benefits of therapy and the expected timeline. Use of a standardized set of intake materials outlining expectations is recommended, with the client receiving a copy for their information. The therapist may consider setting up a boundary management plan with the client which states what will happen if boundaries are crossed. This sets up guidelines not only for the client but for the therapist as well if a boundary crossing is considered. 2. Discuss time. Explicitly establish expectations about session time limits, punctuality, and consequences of repeated tardiness or no shows. Discuss the boundaries around your time for answering client extra-session contacts such as phone calls. Consider whether constant availability may foster unhealthy client dependency or prevent them from solving problems independently. For example, other than crisis situations, phone calls may be confined to administrative issues. 3. Be mindful of self-disclosure. Therapists should reflect on any underlying motives for therapist self-disclosure and consider the risk of undermining the client’s perception of therapist professionalism or competence. Thoughtful consideration of self-disclosure as a potential boundary crossing is crucial. 4. Remain conscious of personal feelings. Be aware of how you feel about spending time with the client. Feelings of excitement, dread, attraction, or dislike may all impact the therapist’s effectiveness and lead to boundary challenges.
5. Reflect on feelings about touch. Attitudes about nonsexual touch and its implications may need to be addressed. Take cues from the client. For example, if the client is grieving and distressed and you’re considering consoling with a hug, ask for the client’s consent first. 6. Boundaries on gift giving. Some therapists have been taught that giving or receiving gifts is never acceptable while others are more flexible on the practice under certain circumstances. Consider the motivation underlying the gift, discuss the boundary directly with the client, and clearly document the gift and the conversation in client notes. Once boundaries are established and agreed upon by the practitioner and the client, a framework for the therapy relationship has been established. These boundaries, however, are not meant to be overly rigid or inflexible. Ethics codes recognize that boundary crossings may be unavoidable or at times even helpful to the client. The codes emphasize that counselors should use discretion when considering a boundary crossing to ensure that precautions are in place to safeguard client welfare. For example, The ACA Code of Ethics (2014) states that if a boundary is extended, the counselor takes precautions to ensure that judgement is not impaired, and no harm occurs (Standard A.6.b). Extending or crossing boundaries in therapy requires careful thought on the part of the clinician. Psychological ethicist Ken Pope in Pope and Keith-Spiegel (2008) discuss nine guidelines which are still widely referenced and should be considered when making decisions involving boundary crossings and whether they are likely to be helpful or harmful to the client. 1. Imagine the best and worst possible outcome from both crossing the boundary and not crossing the boundary. Does the boundary crossing involve risk of negative consequences or risk of serious harm to the client in the short or long term? If harm is a possibility, are there ways to address it? 2. Consider any available research regarding the boundary crossing. 3. Consider guidance offered by professional guidelines, ethics codes, legislation, case law, and other resources. 4. Have at least one colleague that you can trust to give honest feedback about boundary crossing issues with whom you can consult if needed. 5. Pay attention to any uneasy feelings, doubts, or confusion on the clinician’s part and try to identify what is causing them. They note that many of the therapists they consulted with had felt uncomfortable prior to the boundary crossing but ignored it. 6. As part of the informed consent discussion when starting therapy, describe to the client how you work and exactly what type of therapy you do. If the client appears uncomfortable, explore further and if warranted refer to a colleague who may be better suited for the client.
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Book Code: PYFL4024
EliteLearning.com/Psychology
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