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Advance Praise: "Dr. Zur is a bold, effective and intellectually incisive psychotherapist who has delineated appropriate interventions that balance patient need with the finest in ethical conduct. These accord the patient treatment that would otherwise be denied. He has done for the Code of ethics what James Madison did for our Bill of Rights." Nicholas A. Cummings, Ph.D., Sc.D., Distinguished Professor, University of Nevada, Reno; President, Cummings Foundation for Behavioral Health; Former President, American Psychological Association. "This book provides refreshing coverage of one of the most controversial issues in psychotherapy-the subject of psychotherapeutic boundaries. Gone are the blanket rules of avoiding all boundary crossings regardless of client needs, therapeutic settings, and therapist skills. Ofer Zur, a strong proponent of a rational approach, encourages readers to apply a decision-making model that lends itself to careful and creative problem solving with clients." Leon VandeCreek, PhD, Professor, School of Professional Psychology, Wright State University, Dayton, OH; Fellow, American Psychological Association "Dr. Zur's valuable contribution places the ethical proscriptions in today's psychotherapy in a historical context and challenges readers to demonstrate that those proscriptions remain valid. His discussion of boundaries, ethics, and risk management will stimulate independent thinking rather than passive allegiance to the perceived status quo. Dr. Zur advocates exploring and analyzing potential boundary crossings while carefully weighing the costs and benefits for the patient and the treatment. This book will stimulate a great deal of thought and discussion among psychotherapists." Martin H. Williams, PhD, Clinical and Forensic Psychologist, San Jose, CA

TABLE OF CONTENTS Foreword Preface Acknowledgments Introduction Boundary Crossing Versus Boundary Violation Two Types of Boundaries for Psychotherapy Crossing Boundaries While Meeting the Standard of Care Crossing Boundaries While Managing Risk Boundary Shifts in the History of Psychotherapy Boundaries and the Codes of Ethics Map of the Book Part I: Boundaries in Context Chapter 1. Dual Relationships Rural and Isolated Communities Close-Knit Communities College and University Campuses Professional Training Institutes Mandated Dual Relationships in Special Settings Financial Dual Relationships Referrals Coauthors or Collaborators Dual Relationships Ethics of Dual Relationships Dual Relationships in the Context of Therapy Informed Consent To Dual or Not to Dual: How to Decide? Chapter 2. Reflections on Power, Exploitation, and Transference in Therapy Power and Boundaries Slippery Slope Boundaries Transference and Boundaries Chapter 3. Contexts of Therapy Client Factors Therapeutic Setting Setting Factor Therapist Factors Chapter 4. A Decision-Making Process for Boundary Crossing and Dual Relationship Ethical Decision Making Ethical Decision Making Regarding Boundary Crossings and Dual Relationships Risk–Benefit Analysis of Action and Inaction A Decision-Making Process Part II: Boundaries Around the Therapeutic Encounter Chapter 5. Time and Money: Managing Time, Fees, Billing, and Bartering Time Fees, Billing, and Other Money Concerns Bartering Case Study: Cursed by Money Chapter 6. Space for Therapy Home Visits Outdoor or Adventure Therapy Clinical Interventions Not Possible in the Office Ceremonies, Rituals, and Life Transitions Giving or Getting a Ride Incidental Encounters Context of Therapy Confidentiality and Other Considerations in Alternative Therapy Settings Ethics, Standard of Care, CPT, and Risk Management Considerations Case Study: Hospitality With Strings Attached Chapter 7: Home Office Practice Therapist’s Self-Disclosure Managing Time, Place, and People Safety, Privacy, and Confidentiality Client Factors Screening and Informed Consent Ethical Considerations Home Office and Context of Therapy Case Study: A Challenging Setting Chapter 8: Technology for Delivering Care Telehealth and Therapeutic Boundaries Ways That Telehealth Works Clinical, Ethical, and Legal Considerations Guidelines for Using Technology in Psychotherapy Case Study: The Medium Is Not the Message Part III: Boundaries Within the Therapeutic Encounter Chapter 9: Self-Disclosure Self-Disclosure as an Ethical and Boundary Issue Therapist’s Choices in Self-Disclosure The Evolution of Societal and Therapeutic Attitudes Towards Self-Disclosure What the Therapy Setting Discloses Client Considerations Theoretical Orientations Self-Disclosure and Therapeutic Alliance Case Study: Too Much Information Chapter 10: Touch Touch as an Ethical and Boundary Issue Ethics and Standard of Care Considerations Types of Touch in Therapy Scientific and Cultural Views on Touch Touch in Context Case Study: A Touchy Subject Chapter 11: Gifts The Meaning of Clients’ Gifts How Setting Affects the Meaning of Gifts Gifts by a Third Party and Medication Samples Timing and Therapeutic Orientation Therapists’ Gifts Ethics and Keeping Records of Gift-Giving Therapists’ Responses to Clients’ Gifts Case Study: A Blessing in Disguise Chapter 12: Personal Space, Language, Silence, Clothing, Food, Lending, and Other Boundary Considerations Space Between Therapists and Clients Spoken Language Silence Clothing Sharing Food With Clients Lending and Borrowing Greeting and Sympathy Cards Case Study: From Cupcake to Sculpture—Many Ways to Communicate Part IV: Final Thoughts Toward a Better Understanding of Boundaries in Therapy Appendix A: Examples of Boundary Crossings and Boundary Violations in Psychotherapy Appendix B: Ethics Codes on Boundaries and Dual Relationships in Psychotherapy and Counseling References Index About the Author

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