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 Dual or multiple relationships have been a primary area of focus when discussing boundary issues. These describe situations in which the counselor has another relationship with a current or former client outside of the therapy one. There is a secondary relationship between the clinician and the client in addition to the therapy one. Providing therapy to a client’s relative or friend, socializing with a client, or loaning money to a client are examples. Multiple relationships also occur when the therapist takes on more than one role with a person, for example, counselor and supervisor or counselor and business partner. There is an inherent power differential in these relationships that creates the potential for harm or exploitation. The dual relationship could impair the counselor’s judgment or objectivity, and the client could misunderstand the nature of the relationship. While all multiple relationships are boundary crossings, they are not necessarily boundary violations. As previously discussed, Magiste (2020) reported that a survey spanning 28 years of ethics complaints for a
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. 7. Refer to a colleague any client that you feel incompetent to treat or that you do not feel you could work effectively with. 8. Pay attention to informed consent for any planned or obvious boundary crossing. 9. Keep notes on any planned boundary crossing describing why, in your clinical judgment, you feel the boundary crossing is necessary and will be helpful to the client. Finally, Levine and Courtois (2021) point out that not all boundary crossings are planned. When a provider does something outside of the established boundaries, when they make a mistake or break a parameter, it should be brought to the client’s attention and discussed. Sometimes a simple apology is all that is needed, but the feelings and response of the client should be elicited and appreciated. This can repair the relationship and foster trust and understanding.
Clinical Consideration : It is clear that to cross or not to cross a boundary at any particular time in therapy requires careful thought and consideration by the therapist. The therapist must take into consideration the client’s history, culture, values, and diagnosis. Any crossing that is considered should be part of a well- constructed and clearly defined treatment plan that is for the benefit of the client. It should be discussed in full with the client and should be clearly documented in the client’s chart. BOUNDARY CROSSING: NONSEXUAL DUAL OR MULTIPLE RELATIONSHIPS
profession found that, although continuing education audit requirements compromised the largest number of complaints, this was followed closely by complaints related to the nonsexual boundary issue of engaging in a dual relationship. It is no surprise, then, that all of the ethics codes specifically address the issue of dual or multiple relationships in the course of the therapeutic relationship and may also define the type of relationship that is cautioned against. ● ACA (2014) states that counselors avoid extending the boundary of the therapy relationship to include other roles (Standard A.6.b). Prohibited non-counseling relationships include engaging in counseling with persons with whom they have had a previous sexual or romantic relationship or with friends or family members, as it could impair objectivity. Personal virtual relationships with current clients are also prohibited (Standard A.5).
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