Boundaries In Therapy

A kind of renaissance is emerging regarding attitudes towards boundaries in therapy. Old, fear-based dogmas that caution “Never touch a client,” “Do not ever accept gifts,” or “Avoid all dual relationships,” are slowly giving way to a more open process of thought that takes into consideration the uniqueness of the client and the setting of therapy. Perhaps the most illogical of these old dogmas, the idea of the “slippery slope” which claims that any simple touch is likely to lead to a sexual relationship, has been generally discarded as unscientific. Therapists, counselors, ethicists, supervisors, graduate school professors, administrators, professional organizations, courts, and licensing boards are gradually coming to realize that touch can be more clinically effective than words, that self-disclosure is often instrumental in positive therapeutic relationships, that gifts are one of the most basic and healthy human ways to express gratitude, and that dual relationships are not only mandatory in some settings and unavoidable in many others, but in fact they can increase therapeutic effectiveness in certain communities.

BOUNDARIES IN THERAPY-101

• Therapeutic boundaries define the therapeutic-fiduciary relationships and refer to issues of touch, gifts, self-disclosure, dual relationships, home visits, home offices, and out-of-office experiences, etc.
• Boundaries in therapy distinguish psychotherapy from social, familial, business, and other types of relationships.
• Some boundaries are drawn around the therapeutic relationships and include concerns with time and place of sessions, fees, etc. Others are drawn between therapists and clients and include therapists’ self-disclosure, touch, gifts, outside contact, etc.
• Boundary crossings and boundary violations refer to any deviation from traditional, strict, ‘only in the office,’ emotionally distant forms of therapy, or any deviation from rigid risk-management protocols.
• Boundary violations occur when therapists cross the line of decency and violate or exploit their clients.
• Boundary crossings often involve clinically effective interventions, such as self-disclosure, home visits, non-sexual touch, gifts, or bartering.
• Dual relationships refer to any situation where multiple roles exist between a therapist and a client, i.e., when the client is also a student, friend, family member, employee or business associate of the therapist.
• Boundaries in therapy can only be understood within the context of therapy, which includes client, setting, therapy, and therapists’ factors.
• Boundary crossings can be an integral part of well-formulated treatment plans or evidence-based treatment plans. Examples are, flying in an airplane with a patient who suffers from a fear of flying, having lunch with an anorexic patient, making a home visit to a bed ridden elderly patient.
• Potentially helpful boundary crossings also include giving a supportive or greeting hug, sending greeting cards, exchanging appropriate gifts, lending a CD, attending a wedding, confirmation, or Bar Mitzvah, or going on a hike.
• Ethics codes of all major psychotherapy professional associations do NOT prohibit boundary crossings, only boundary violations.
• Therapeutic orientations, such as humanistic, cognitive-behavioral, family, feminist, or group therapy are more likely to endorse boundary crossings as part of effective treatment than analytically or psychodynamically oriented therapies.
• Like dual relationships, boundary crossings are normal, unavoidable, and expected in small communities such as rural, military, university, and interdependent communities such as gay or ethnic.
• Neither risk management practice nor do analytic standards define the professional standard of care in regard to boundaries.
• Imposing analytic standards regarding boundaries upon humanistic and other orientations is professionally inappropriate and may even be unethical.

The Zur Institute offers numerous Free Articles on touch, gifts, dual relationships, bartering, self-disclosure, and much more.