Therapeutic boundaries

Professional Boundaries 

Research has shown that therapeutic success predominately depends on the therapeutic relationship; therefore, clinicians need to be mindful and have specific strategies in place when it comes to boundaries. Boundaries overall in the context of therapy affords a safe place, protecting vulnerable clients and professionals alike from potential unintentional risks/harms to all parties involved.

There are many boundaries that need to be considered and assured in working with clients, not only should you consider your clients but also your role in the matter, as setting certain boundaries are encouraged, while others are required for the sake of ethical and professional work and outcome.

There are different types of boundaries to be considered, some of which are not concrete. For instance, there are physical boundaries (physical closeness-proximity (considering culture and diversity implications)), relational interactions (should remain as professional and client not social, friendly, etc.), time boundaries (respects everyone's time-professional), and mental and emotional boundaries (preventing attachments (emotional enmeshment) and counter-transference).

Clinicians must remember their role and what it means to fulfill that role. Many times clinicians have good intentions, to "being helpful," but professional lines can be crossed, and if there is any jeopardy of potential-questionable ethical concerns, it's best to reflect and consider what are some of the underlying concerns, as there may be certain topics and/or populations that may trigger clinicians to respond a certain way that may be considered perhaps inappropriate or unhealthy in the long run for the clients or the clinician. Consulting with other mental health professionals is a must to minimize risks of harm for the clients and the professional, as some incidents can result in losing their professional license.

Before addressing what maybe some of the principles that informs healthy boundaries, I would like to encourage clinicians to always reflect on their therapeutic work to consider and identify what is informing their stance (assumptions, concepts, questions, interventions) to assure it's based on an appropriate and effective theory and model (Evidence base practice (EBP)), as oppose to the clinician's own distorted ideas, biases, or agenda. Keep alert for signs when healthy boundaries are not being kept, perhaps one sign can be the emotional toll the case has on the clinician, the amount of time and energy spent by the clinician that surpasses what is "typical and appropriate," or spending time with clients outside the therapy session, etc. all of which are inappropriate.

So how can all this be prevented? For one, the most straightforward step would be setting the expectations of therapy (review the consent form), the therapeutic relationship, and the time boundaries (the appointment scheduled considering the client's culture and diversity (be sensitive). Another critical point in minimizing risks and helping with assuring healthy boundaries is the continuous intentional development of cultural and diversity competencies and sensitivities (EBP research), which would inform the boundaries in place. Another is for clinicians to be mindful of their own emotional and mental wellbeing, in noticing if the case is triggering certain emotions and/or thoughts, burnout, poor judgment, or transferences (potentially based on the topic and/or an affinity to certain cultures and diversities (biases)).

According to Corey (1996), healthy boundaries are based on five different principles:

• Beneficence is where the therapist recognizes the importance of doing what is best for the client and benefits the client the most. It is an action that is done to benefit the client.
• Nonmaleficence refers to the therapist who avoids any activities that may do harm to the client. This is compared to the Hippocratic Oath of do no harm to the client.
• Autonomy is when the therapist promotes the client being independent from them. Autonomy helps clients make their own decisions.
• Justice is when the therapist gives counseling that is equal and fair and does not show favor. Justice can involve equity, access, participation and harmony.
• Fidelity is being honest and committed to helping the client make progress

Reference

Corey, G. (1996). Theory and practice of counselling and psychotherapy. CA: Brooks/Cole.

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