While many of these activities and beliefs may seem like a boundary crossing on the surface, in the context of the client’s culture they may actually represent the norm. Herlihy (2017) offers several suggestions when working with culturally diverse populations: 1. When entering into a therapeutic relationship with a client from an unfamiliar culture, educate yourself on the norms and customs of that culture in order to avoid making a boundary-related mistake. 2. If possible, talk with other mental health professionals who are familiar with that culture and can advise you on potential boundary issues that you might encounter and how they can be resolved in a culturally appropriate way. 3. When a boundary issue arises, work directly and transparently with the client to resolve it. 4. Be open to working collaboratively with other providers in that culture, such as religious leaders. 5. Make self-reflection a habit. a. Does the boundary enhance or hurt the client’s sense of safety? b. Is the boundary meeting the client’s needs or the therapist’s needs?
c. If a dual relationship is considered, will it enhance the therapeutic relationship? d. Before shifting a boundary, has it been discussed with the client so that they understand and accept the change? e. Has a risk–benefit analysis been done, evaluating the best- and the worst-case outcome of the boundary crossing? Corey and Corey (2021) add that counselors should not make assumptions about verbal and nonverbal behavior. Cultural expressions like personal space requirements, eye contact, handshaking, forms of dress, and importance of time may all vary among different cultural groups. Therapist behaviors like probative questions or confrontational style may be offensive to some clients from other cultures. Directness on the part of the counselor may be viewed as rude in some cultures. A behavior that constitutes a boundary crossing in one group may be the norm in another. The clinician must be aware of these differences, or they run the risk of inadvertently engaging in a boundary crossing.
CONFIDENTIALITY AND PRIVACY BOUNDARIES
● NBCC (2023) states that counselors shall not share client information that is obtained in the counseling process except when necessary to prevent serious and foreseeable harm to the client or others or as mandated by law (Standard 19). ● AAMFT (2015) states that therapists do not disclose client confidences except by written authorization or where mandated by law (Standard 2.2). All professional codes of ethics are clear that maintaining the boundaries of confidentiality is crucial for establishing trust in the therapy relationship. There are times where this boundary must be crossed, for example in situations of child abuse or neglect. Each state has their own set of laws governing situations of mandated reporting and the ethical clinician stays up to date on those laws. That information should be clearly outlined in the initial informed consent agreement at the beginning of the therapy relationship. It should also be reviewed and discussed if a situation arises where potential disclosure is an issue. Other areas where there is the potential for crossing the confidentiality boundary include group treatment, family treatment, and couples counseling. In these situations, it is important for the counselor to address the limits and boundaries of confidentiality with every person involved in the relationship and, again, this should be clearly described in the initial informed consent documents.
Privacy and confidentiality are essential components of the therapeutic relationship. They provide the foundation for developing trust in the relationship. If the client does not have a sense of trust, the likelihood that they will engage in significant self-disclosure and self-exploration declines. The client must trust that the information they disclose in therapy will remain private between the client and the therapist. Confidentiality relates to the information that is collected by the therapist, and the boundaries and limits are dictated by federal and state laws, as well as by ethics codes and professional licensure and regulations. Clinicians have a primary obligation to take reasonable steps to protect confidential information from disclosure except in certain situations. It is one of the most basic ethical obligations but is also one of the most problematic areas in practice. ● NASW (2021) states that social workers should protect the confidentiality of information obtained except for compelling professional reasons when disclosure is necessary to prevent serious, foreseeable and imminent harm to the client or others (Standard 1.07). ● APA (2017) states that psychologists have a primary obligation to protect confidential information obtained through any medium recognizing that the extent of confidentiality may be regulated by law (Standard 4.01). ● ACA (2014) states that counselors protect the confidential information of prospective and current clients and disclose information only with sound legal or ethical justification (Standard B.1.c).
TELEHEALTH AND BOUNDARIES
A discussion about boundaries and ethics would not be complete without addressing telehealth services. Telehealth is an emerging area of practice which has become increasingly popular. In addition to convenience, it allows for the provision of services to persons who might otherwise be unable to access them. Persons who live in remote areas, persons who have no transportation, or persons who are physically homebound are some populations which have benefitted. A thorough discussion of telehealth is beyond the scope of this course. Every state and jurisdiction and every professional licensing board has developed laws and regulations regarding the practice of telehealth. Providers are encouraged to become familiar with those if they intend to engage in telehealth services since there is the potential for boundary crossings or boundary violations in
the use of telehealth technology, mainly as they relate to confidentiality and cross-state services. ● NASW (2021) states that social workers who provide electronic social work services should be aware of cultural and socioeconomic differences among client’s use of and access to electronic technology (Standard 1.05). They should have the knowledge and skill to use the technology in a competent manner and their use of technology should comply with the laws governing its’ use (Standard 1.04). They should take steps to protect the confidentiality of electronic communications and should use safeguards to protect confidentiality (Standard 1.07).
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