● Boundaries help the clinician separate themself from their client by drawing a distinction between the clinician’s personal issues and those of the client. ● Boundaries fostered a sense of confidence and competence on the part of the counselor. They provided a framework within which therapy decisions were made, reducing therapist anxiety about competence. ● Boundaries helped reduce anxiety or fear surrounding judgment by others through client or professional colleague complaints. 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. ● 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
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 complaints 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. Blundell and colleagues (2022) explored how counselors understand and experience boundaries in their practice. All participants understood that professional boundaries were important for offering protection and safety to the client. They also understood that those boundaries also provided safety to the clinician since the power imbalance in therapy is not always toward the therapist. There are times where it shifts to the client, for example, when the client holds a position of power or authority in the community (e.g., court judge, police officer). Respondents in the study specifically noted that: ● Professional boundaries help the clinician protect themselves from the demands of their work. For example, boundaries related to session length and office hours help prevent professional burn out.
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.
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Book Code: PYTX1325
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