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Ethics and Morality
My Boundaries Are...
Too loose of boundaries or just right?
Posted October 21, 2011
The word boundary conjures up the idea of separation or space between two entities; it indicates where one person and their emotional needs end and where another person and their emotional needs begin (Kitchener & Anderson, 2011). In psychotherapy, boundaries refer to the psychological, emotional, and physical space between the therapist and the client.
Another way to think about boundaries, especially in the psychotherapy, is to ask the question: What behaviors are part of a psychotherapy relationship and what behaviors are not? It is certainly appropriate when a client shares a very personal experience with the therapist in the therapeutic relationship. However, when a therapist reciprocates and shares something very personal with the client, is that appropriate? There are clear examples of inappropriate behaviors such as therapists having sex with clients. This behavior is considered a clear boundary violation. But as in most ethical issues, negotiating boundaries leads us into more difficult decisions and into gray areas. Thus, we need think more carefully about them. To start this thinking process, finish this sentence:
"My boundaries are ________."
Psychotherapists would likely fill in this blank differently depending on their professional stance. Some psychotherapists might say, "Boundaries are absolutely necessary." Other therapists might state, "Boundaries are troublesome barriers." Still others might suggest, "Boundaries are part of the profession, but impractical in most cases." We would say, "Boundaries are critically important and sometimes need to be pliable for healthy psychotherapy relationships."
Boundaries are meant to be beneficial in the professional relationship. Psychotherapy can be an emotionally intimate relationship and the relationship between the psychotherapist and client is a key factor in successful outcomes (Gelso & Hayes, 1998). A warm and kindly therapist, who understands the client's emotions and thought processes, is likely better at fostering or encouraging good work by the client. At the same time we know that being too warm, kind, and understanding might lead to boundary issues. From our perspective, the psychotherapy relationship is not only intimate, it is also fragile. The therapist has the professional responsibility to keep the client's wellbeing as the primary focus of the relationship. When a psychotherapist loses sight of this responsibility, a boundary lapse is likely to happen. We know from research that poor boundaries, specifically those that end up in sexual relationships, are disastrous for clients (Bates & Brodsky, 1989; Noel & Watterson, 1992).
At same time, we agree with others that boundaries have to be flexible (Austin, Bergum, Nuttgens, & Peternelj-Taylor, 2006). As professionals we have personal lives and none of us lives in isolation (Sommer-Flanagan & Sommer-Flanagan, 2007). Thus, our paths are likely to cross with clients and former clients, and they often do so at unsuspected times and in uncanny ways. For example, we might run into a client at a social event like a concert, or a political rally for a candidate. We might have children who participate in an event or activity in which a client's children also participate. As ethical psychotherapists, our goal is to be vigilant and diligent about when boundaries with clients need to remain firm and when they need to change because the situation calls for such an adjustment and the client would likely receive some type of benefit from the change. The literature refers to these changes as boundary extensions or boundary crossing. Boundary extensions and crossings suggest a temporary change in the relationship by the psychotherapist for the benefit of the client (Sommer-Flanagan et al, 1998; Remley & Herlihy, 2007). At the same time, our humanness as psychotherapists makes us vulnerable to the "slippery slope" phenomena (Anderson & Handelsman, 2010; Sonne 1994). Ethicists suggest that small steps of loosening boundaries can progressively end up in harmful and exploitative psychotherapist behaviors (Gabbard, 1989, 1994; Gutheil & Gabbard, 1993; Simon, 1989; Strasburger, Jorgenson, & Sutherland, 1992). The client's wellbeing is of primary importance and psychotherapists need to think through whether a modification in boundaries will benefit or harm the client.
"My boundaries are..." So, how did you fill in the blank?
This post was co-written with Mitchell M. Handelsman, PhD, whose blog is "The Ethical Professor" and who co-authored the book Ethics for Psychotherapists and Counselors.
Anderson, S. K., & Handelsman, M. M. (2010). Ethics for psychotherapists and counselors: A proactive approach. Malden, MA: Wiley-Blackwell.
Austin, W., Bergum, V., Nuttgens, S., & Peternelj-Taylor, C. (2006). A re-visioning of boundaries in professional helping relationships: Exploring other metaphors. Ethics and Behavior, 16, 77-94.
Bates, C. M., & Brodsky, A. M. (1989). Sex in the therapy hour: A case of professional incest. New York: Guilford.
Gabbard, G. O. (1994). Reconsidering the American Psychological Association's policy on sex with former patients: Is it justifiable? Professional Psychology: Research and Practice, 25, 329-335.
Gelso, C. J. & Hayes, J. A. (1998). The psychotherapy relationship. New York: Wiley
Gutheil, T. G., & Gabbard, G. O. (1993). The concept of boundaries in clinical practice: Theoretical and risk-management dimensions. American Journal of Psychiatry, 150, 188-196.
Kitchener, K. S., & Anderson, S. K. (2011). Foundations of ethical practice, research, and teaching in psychology and counseling (2nd ed.). New York, NY: Routledge/Taylor & Francis Group.
Noel, B., & Watterson, K. (1992). You must be dreaming, New York: Poseidon Press.
Remley, T. P., & Herlihy, B. (2010). Ethical, legal, and professional issues in counseling (3rd ed.). Upper Saddle River, NJ: Merrill
Simon, R. I. (1989). Sexual exploitation of patients: How it begins before it happens. Psychiatric Annals, 19, 104-112.
Sommers-Flanagan, R., Elliott, D., & Sommers-Flanagan, J. (1998). Exploring the edges: Boundaries and breaks. Ethics and Behavior, 8(1), 37-48.
Sommers-Flanagan, R. S., & Sommers-Flanagan, R. (2007). Becoming an ethical helping professional: Cultural and philosophical foundations. Hoboken, NJ: Wiley & Sons.
Sonne, J. L. (1994). Multiple relationships: Does the new Ethics Code answer the right questions? Professional Psychology: Research and Practice, 25, 336-343.
Strasburger, L. H., Jorgenson, L., & Sutherland, P (1992). Prevention of psychotherapist sexual misconduct: Avoiding the slippery slope. American Journal of Psychotherapy, 46, 544-555.
