Establishing Appropriate Boundaries
Therapeutic relationships are intricate, dynamic systems of healing and trust, defined by boundaries. Similar to state lines on a map or borders between countries, however, many boundaries are invisible and, in certain cases, imperceptible to those engaged in a therapeutic relationship. Although many people find maintaining healthy boundaries in a therapeutic relationship relatively easy, certain people struggle from the very beginning—while others run into unanticipated difficulties only after the relationship deepens.
Boundary Violations to Watch for and Avoid
Professional psychotherapists and mental health practitioners are beholden to a code of ethics and guided by core moral principles intended to help clearly define their role in the context of therapeutic relationships. For example, as part of their education and specialized training, therapists are unanimously taught that sexual relationships, fraternizing with clients outside of work, and sharing transportation or housing arrangements are all taboo and highly problematic.
Other taboo and highly problematic areas include, but are not limited to, the following:
- Playing favorites with a client or clients
- Bribery or sharing personal gifts
- Expressing romantic interest
- Lying about insurance billing
- Conducting therapy sessions in public
- Friendship with current clients on social media
Despite the professional and ethical responsibility upheld by most therapists, cases of major boundary violations appear in newspapers daily— and, for every boundary violation reported, legions more go unreported or are considered not serious enough to warrant further investigation. In fact, many boundary violations occur within the context of good intentions and are subtle enough to appear harmless; for example, a sexual joke, a kind remark regarding the appearance of a client of the opposite sex, or excessive personal disclosure when triggered by an emotionally provocative topic.
Negotiating Boundaries During the Various Phases of Therapy
By some estimates, almost every long-term therapist has intentionally or unintentionally crossed, or come close to crossing, the invisible line of demarcation between what is appropriate and inappropriate within the therapeutic relationship. To clarify a common misconception, therapeutic relationships are not only comprised of two participants. Therapy also occurs within group contexts, family units, and educational settings and is in no way limited to a two person dynamic, even though that is its most common expression. Regardless of the number of clients a therapist is treating, their primary responsibility lies in maintaining a positive, supportive role irrespective of a client’s issues throughout the following phases of therapy:
- The orientation phase – the initial period where the client and therapist get acquainted and begin to develop a therapeutic alliance. This phase includes completion of important clinical documentation and allows the therapist the opportunity to ask basic questions relevant to the client’s presenting issues and current life situation. It also provides the client an opportunity to discuss treatment goals, clarify treatment expectations, and better understand the therapist’s clinical approach.
- The identification phase – this phase involves further assessment and clarification of presenting issues, helping define specific diagnoses and establishing treatment objectives in unison with the client. Many therapists formulate an official treatment plan during this phase to be completed within an expected timeframe for optimal treatment outcomes.
- The working phase – this phase involves the client taking initiative for the fulfillment of treatment plan goals and addressing presenting issues. This is a critical phase of treatment that can make or break successful outcomes, depending upon how committed clients are to working a program, coupled with their level of self-honesty.
- The resolution phase – this phase marks the beginning of the termination process and allows the client the opportunity to find closure and a sense of independence upon completion of the program. It also allows the therapist and client to identify and resolve any remaining issues prior to discharge.
At any stage of the therapeutic process, boundary issues may arise. It is incumbent upon the therapist to clearly articulate expectations and professional standards prior to delving into therapy and, subsequently, should any issue arise.
In some cases, clients may not even be aware that their behavior constitutes a boundary violation, and the very same applies to therapists— although they have a professional, ethical responsibility to be aware of boundaries at all times. Therapy can be a very intense, vulnerable process for clients and therapists alike, and the subtle, nuanced dance of a successful therapeutic relationship requires clear communication combined with a tireless commitment to personal and professional ethics. Always remember, like the median on a highway or edge of a cliff, certain boundaries are dangerous when crossed and can cause lasting or irreversible harm.