Boundaries in the patient-practitioner relationship 12 Boundaries define the limits of appropriate behavior by a professional toward his or her clients. By establishing boundaries, a health care professional creates a respectful and protective space for the therapeutic relationship to occur. A boundary violation occurs when a health care professional’s behavior goes beyond appropriate professional limits. The intimate nature of massage therapy includes practitioners in important and sometimes highly stressful life events, and the mutual dependence of colleagues working in close concert all present the potential for blurring of limits to professional relationships. Remaining within the bounds established by the purpose of the relationship can be especially difficult in prolonged or long-term relationships. Even so, in all encounters, practitioners are responsible for retaining their professional boundaries. A variety of standards establish the limits of appropriate professional behavior, whether those limits are explicitly enumerated in standards of conduct, codes of ethics, or law, or tacitly conveyed through professional training and widespread acceptance. Individuals who seek help must rely on the professional they consult to be trustworthy: When practitioners behave in ways that call their professional judgment and objectivity into question, the trust on which the relationship depends is compromised. And when trust is compromised, the efficacy of the therapeutic relationship is negatively affected. Part of your responsibility in maintaining clearly defined boundaries is to protect the client from you, should you act or speak inappropriately, or be motivated by anything but your client’s best interests. Inappropriate behavior tends to make people uncomfortable. If you notice that a client Personal boundaries and self-disclosure Self-disclosure is the process in which the practitioner reveals personal (rather than general or professional) information about him/herself to the client. There are many different motivations for and types of self-disclosure. An incident may be deliberate or accidental, initiated by either the client or the therapist, and can be spoken or unspoken. An example of unspoken intentional self-disclosure is how you choose to decorate your workplace (with careful selection of a meaningful poster or picture, or a family photo, for example). Some self-disclosure is unavoidable, as your presence communicates facts about you such as your gender, and approximate age, etc. Some disclosure is accidental because it is not meant to be shared but is communicated through body language or tone of voice. Accidental self-disclosure also occurs in cases where a practitioner bumps into a client unexpectedly, when both are sitting in their doctor’s waiting room, for example. You may or may not want to disclose information about why you are there, and it may be difficult to find a safe middle ground, revealing enough to be professional and friendly, but not enough to compromise your own personal space and privacy. Exactly where should you draw the line? It is helpful to ask yourself two questions before self-disclosing: (a) how will it benefit the client? and (b) how will it affect your professional boundaries? You should also consider your own privacy. For example, what if you and your client attend the same Alcoholics Anonymous meeting? Would this make it hard for Dual/multiple role relationships A dual or multiple role relationship occurs when an individual either at the same time or different points in time engages in two role categories, for example, in addition
is not responding positively to massage therapy, make sure your behavior or comments are not a contributing factor. Relieving stress and physical stiffness or pain should be a relaxing and comfortable experience. If your behavior is appropriate but your client appears anxious or uncomfortable in the session, discuss your concern with the client. A boundary violation occurs when a health care professional’s behavior goes beyond appropriate professional limits. Boundary violations generally arise when a personal interest displaces the professional’s primary commitment to the patient’s welfare in ways that harm the patient or the patient-practitioner relationship. Interactions between health care professionals and clients are ethically problematic when they can reasonably be expected to affect the care the individual or other clients receive or the health care professional’s relationships with colleagues – or when they give the appearance of doing so. Boundaries are breached in two ways. Some breaches are inadvertent or not intentionally exploitative. These are known as boundary crossings . Commonly cited examples are a goodbye hug initiated by your client at the completion of treatment; non-sexual physical reassurance at times of extreme stress; running a session overtime; or selective self-disclosure. Repetitive boundary crossings are potentially harmful because they blur the boundary, thereby increasing the chances of boundary violation. Boundary violation is a significant and potentially harmful breach where the practitioner overrides the client’s rights or actually does harm to the client. Some examples are: affectionate or flirtatious communication; self-disclosure about the practitioner’s personal problems; or breaking confidentiality. you to get the full benefits of attending the meeting during times of stress or relapse? Self-disclosure is not always conscious and deliberate. Words can be blurted out, poorly thought out, or tinged with emotion. When in doubt, do not self-disclose. In a similar vein, it is usually best to keep emotional responses or judgments (both negative and positive) to yourself. A good rule of thumb is to monitor your own feelings without imposing them on your client. If you are distracted by a strong feeling, mentally put it to one side. Wait until after the session, then talk with a peer or supervisor or deal with it personally. As with other boundary crossing, self-disclosure should be client-focused, based on the welfare of the client. Different clients and practitioners have different personal boundaries, so appropriate boundaries must function within the client’s comfort zone. Remember that those personal and professional boundaries exist for the benefit of both the practitioner and the client. Changing or moving boundaries, which are the limits within which the therapeutic relationship occurs, results in an unclear or ambiguous relationship that is a risk to the safety of the client, although it may not appear to have negative repercussions at that time. Transgressions often have delayed consequences that do not appear harmful initially. Detecting boundary violations is complicated by the fact that transgressions are more often a process than an individual event or occurrence. Boundary violations may be subtle, or masked by the professional/patient relationship.
to the professional therapeutic relationship, there is also another relationship, such as relative, friend, student, business partner, or instructor. While it is perhaps best
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Book Code: MNJ0524
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