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. ● 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
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.
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