This brief paper discusses the importance of a therapeutic relationships and issues of maintaining professional boundaries including types of boundaries, guidelines for maintenance, and common errors of judgment.
Professional Issues Reflection Paper: Boundaries
As a student therapist who is working on completing her internship hours, I have become profoundly aware of the importance of boundary setting in the context of a therapeutic relationship. Buhari (2013) describes therapeutic relationships as based on the following characteristics: (1) a power-imbalance; (2) trust; (3) empathy; (4) respect; (5) emotional intimacy, and (6) a therapeutic alliance. The driving goal of therapeutic relationships is to address the client’s needs first and foremost. As the therapeutic relationship becomes solidified, therapist get to know their clients intimacy and learning to maintain professional boundaries is critical (Buhari 2013). In an audiotaped interview segment, Carl Rogers makes a statement on the concept of empathy. The following quote from a YouTube provides an overview of the audio recording of Carl Rogers discussing the concept of empathy. This video highlights one critical aspect of the therapeutic relationship and the importance of boundary setting (Rutsch, 2015).
“When I can let myself enter softly and delicately into the vulnerable inner world of the other person…lay aside my views and values and prejudices…check the accuracy of my acceptance of him or her…then I can be a companion to that person, pointing at the felt meaning of what is being experienced (Rutsch, 2015).
The Zone of Helpfulness
The goal of therapy is to facilitate communication of the client’s thoughts, feelings, and beliefs in order to examine them critically, uncover unhealthy belief systems, maladaptive coping tools and self-destructive behaviors (Herlihy & Corey, 2015). One resource for this paper discusses the concept “Zone of Helpfulness” (Buhari, 2013, p. 162) when discussing the issue of boundary setting. This Zone of Helpfulness” (Buhari, 2013, p. 162), rests within a continuum of involvement between two opposing extremes with enmeshment on extreme and aloofness on the other. It is critical for new therapists to develop a conceptual understanding of where this “Zone of Helpfulness” (Buhari, 2013, p. 162), rests in their daily practice. The following concepts have been a useful guide for me lately.
Types of Boundaries & Boundary Violations
Definition of Professional Boundaries
Buhari (2013) defines a boundary as a “dynamic line which if crossed will constitute unprofessional or unethical behavior. In other words, professional boundaries are useful in defining the “Zone of Helpfulness” (Buhari, 2013, p. 162), in a therapeutic relationship. They are important as mutually understood standards of conduct defining the limits of a relationship between therapist and client.
Types of Boundaries
Buhari (2013) also discusses types of boundaries that are useful in defining a critical aspect of the therapeutic relationship. For example, physical boundaries define rules of acceptable physical interaction (i.e. shaking hands, or hugging) (Buhari, 2013). They tend to be socially-defined concepts that define how much of the physical space around us is concerned personal. In this respect, physical boundaries define how closely people tend to stand when engaging in casual conversation.
Buhari (2013) also describes abstract boundaries as pertaining to attitudes regarding what behaviors considered rude, abrasive, or disrespectful. This element of boundary setting in a therapeutic relationship sheds light on the importance of multicultural sensitivity. For example, in my mother’s culture it is considered important to respect your elders. This would mean, calling an older client “Mr. So-and-So” until they gave you permission to use their first name.
Inner boundaries are highly relevant to Carl Roger’s definition of empathy provided earlier, (Rutsch, 2015). Being aware for issues of counter-transference issues is critical when setting inner boundaries. It also requires self-awareness, for example I work in the nursing field and tend to people’s needs all day. Doing this in an inpatient therapeutic setting is not always therapeutic or helpful to my clients in the long run. Finally, Buhari, (2013), describes interpersonal boundaries as occurring between the client and therapist relationship: (i.e emotional, verbal, and behavioral).
ACA Code of Ethics
The ACA Code of Ethics states the following regarding professional boundaries. Firstly, prohibits romantic and/or sexual relationships between therapist and client (American Counseling Association, 2014). Secondly, it cautions therapists to consider previous relationships with an individual before accepting them as a client (American Counseling Association, 2014). Thirdly, the ACA Code of Ethics warns therapists to careful consider actions that might bypass conventional parameters such as going to a client’s wedding (American Counseling Association, 2014). Finally, the ACA Code of Ethics stresses the importance of carefully documenting all actions taken to extend the boundaries in the therapeutic relationship (American Counseling Association, 2014).
Defining the Parameters
When meeting clients for the first time it is essential to be clear right from the outset the parameters that define the therapeutic relationship (Buhari, 2013). This should include discussing the nature of the therapeutic and purposes of therapy. Relevant issues such as: (1) limits to confidentiality, (2) method of payment, (3) office policies, (4) setting, (5) duration and (6) frequency of services, should also be discussed. Issues to consider carefully involve an examination of the therapeutic benefits of self-disclosure and the possibility of dual relationships.
Ethical Decision Making tips
Pope, et al, (2008) suggest knowing ethical codes while also considering boundary setting issues in terms of their alternative therapeutic outcomes. For example, while ethical codes state that gift giving between client and therapist are inappropriate, there are some rare instances in which it may be culturally insensitive reject a gift. In this respect, ethical decision-making should first entail a careful examination of all relevant aspects of a situation. Pope, et al, (2008), stresses the importance of self-awareness in the decision making process so we can clearly define the feelings and thoughts that underlying these ethical decision. Finally, having colleagues to discuss these issues can be a useful reality check. An article titled “To Cross or Not to Cross” (Zur, 2004) cautions against being overly rigid with boundaries since it can decrease therapeutic effectiveness and can at times cause harm to the client (p. 30). A common misconception exists regarding boundary called the “slippery slope argument [in which] crossing of boundaries inevitably lead to a violation” (Zur, 2004, p. 30). Ultimately decision making based on three critical factors: client welfare, ethical standards, and therapeutic effectiveness (Herlihy & Corey, 2015 & Zur, 2004).
Errors in Judgment.
Boundary violations include deliberate actions that are clearly inappropriate crossing the line of decency (Buhari, 2013; Zur, 2004). They include misuses of influence and power of the client for the therapist’s own benefit (Buhari, 2013; Zur, 2004). While the process of boundary setting might at first appear straightforward, the ethical decision-making requires us to consider factors that often contradict one another. They must be made cautiously, with a clear understanding of all relevant aspects of a situation. To illustrate this point, Pope, et al, (2008), provides a list of common errors in judgment regarding the issue of boundary setting. When reading through this list there are a few that stand out to me as quite insightful. Firstly, Pope, et al, (2008) state that the felt meaning regarding an act that crosses boundaries can vary between client and therapist. This is especially true if the client and therapist have different cultural backgrounds. Secondly, Pope, et al, (2008) note that these decisions should be taken on a case-by-case basis. In other words, what might be a therapeutic boundary crossing in one instance can be considered harmful in another, (i.e. receiving a small gift).
How to Correct Errors in Judgment
The ACA Code of ethics cautions therapists to carefully consider and document all events involving a crossing of boundaries (American Counseling Association, 2014). In the event that the outcome of this decision isn’t what we had hoped, Pope, et al, (2008), provides some useful guidelines. Firstly, Pope, et al, (2008) state it is important to carefully monitor the situation, and remain “open and non-defensive” (p. 648). This can allow you to fully understand the client’s perspective. Discussing the situation with your supervisor and colleagues. Finally, Pope, et al, (2008) states it is important to show professional responsibility by claiming ownership of our mistakes and apologizing if necessary.