In the realm of therapy, the preservation of ethical boundaries can be fundamental to fostering a healthy therapeutic relationship. Therapists must navigate the therapeutic relationship carefully, ensuring they are aware of potential biases and that the primary focus remains on the client’s well-being. The violation of these boundaries may lead to harmful consequences, potentially compromising the trust and rapport established with clients as well as the career and licensure of practitioners.
Boundary violations are often complex issues that blur the lines of professional conduct. Being attentive to the nature of the therapeutic alliance and staying aware of the most common violations may help therapists be more mindful of how they approach client relationships. Keep reading to learn more about the importance of setting healthy boundaries in the therapeutic setting and how you can avoid blurring the lines set by the code of ethics you’re bound to.
What Are Boundary Violations In Therapy?
Boundary violations in therapy refer to instances where therapists may overstep the professional lines established by the ethics code, potentially leading to harm to the client and a compromised ability to deliver unbiased treatment.
Ethical boundaries establish clear rules and guidelines for mental health professionals and define the therapeutic territory. If boundaries are ignored, practitioners may find themselves acting in their own best interest, consciously or unconsciously, instead of the patient’s. This is often a difficult situation for therapists due to the difficulty in identifying the presence of violations within the context of one’s own biases.
It can be essential to note that not all boundary crossings and violations are harmful or unethical, but they do require careful consideration and scrutiny. Appropriate boundaries are a vital element of any therapeutic relationship, establishing the structure and safety necessary for effective therapy. The therapist’s role is to remain mindful of these boundaries, ensuring that their interactions with clients are professional and that their theoretical orientation remains pointed in a beneficial direction. Violations of these boundaries may risk the trust and the therapeutic alliance built between the client and therapist, and therefore compromise clinical decision-making.
Types Of Boundary Violations
In order to avoid boundary violations, it can be helpful to be aware of some of the most common areas in which therapists might overstep. Being cognizant of these limits can help you establish healthy, straightforward guidelines for your own practice. Within the therapeutic setting, the most common types of boundary violations include:
- Multiple Relationships
Multiple relationships, also known as dual relationships, refer to situations where a therapist has more than one type of relationship with a client. This could include social, familial, or business relationships beyond the professional therapeutic connection. While therapy requires a certain level of trust and understanding, it can be crucial to maintain professional boundaries to avoid the potential for conflicts of interest or ethical dilemmas.
Therapists are advised to avoid multiple relationships that could impair their professional judgment or risk exploitation or harm to the client. The American Psychological Association (APA) outlines explicit guidelines concerning multiple relationships in clinical practice. According to the APA’s ethics code, a multiple relationship transpires when a therapist is in a professional role with a person and simultaneously has another role with the same individual or with a person closely associated with that individual.
The APA cautions therapists about the potential for impaired objectivity, competence, or effectiveness in performing their functions as a psychologist due to a dual relationship. For example, entering into a business relationship with a client could blur the lines of the therapeutic relationship, creating a potential conflict of interest. Similarly, a familial or social relationship with a client could lead to biased clinical practice, which could ultimately be detrimental to the client’s therapy. It can be vital for therapists to understand and navigate these boundaries responsibly to maintain the integrity of the therapeutic relationship.
According to research, it is recommended that practitioners use their best professional judgment when making decisions regarding boundaries with clients or when contemplating multiple relationships. Specifically, researchers mention how therapists should consider where the motivation and intention of their decision-making lies, if the nature of the relationship results in dependency, and what types of risks and benefits may occur.
- Self-Disclosure
Self-disclosure in clinical practice refers to the act of therapists revealing personal information about themselves to clients. Self-disclosure may range from sharing minor details about one’s life to discussing significant life events or personal struggles. While self-disclosure can be a potent tool to forge a stronger therapeutic relationship, it can be crucial to balance it without crossing professional boundaries.
When used judiciously, self-disclosure may enhance the therapeutic alliance and help clients feel understood and less alone in their experiences. However, therapists need to consider whether the disclosure is for the benefit of the client or to satisfy their own emotional needs. The therapist’s well-being and mental health shouldn’t overshadow the client’s needs.
By sharing personal experiences or emotions, therapists may inadvertently shift the focus of therapy from the client to themselves, resulting in a blurred boundary that can compromise the effectiveness of treatment. This can potentially lead to a power imbalance and make the client feel tied to the therapist’s emotions, which may compromise their ability to render effective treatment.
Additionally, inappropriate or excessive self-disclosure might cause distress or confusion for the client, potentially undermining the safe, supportive environment that is often critical to successful therapy. It can be imperative for therapists to maintain professionalism, compassion, and empathy, prioritizing the client’s well-being and therapeutic progress before engaging in self-disclosure.
- Uneven Treatment
Uneven treatment is a form of boundary violation that may significantly impede effective treatment and result in potential harm to clients. This can manifest in various ways, such as overscheduling certain types of clients based on personal preferences or unconscious bias, or uneven treatment strategies based on the nature of relationships with certain clients. This can lead to a skewed perception of client needs and compromise the fairness and equity of delivery of care.
Accepting gifts from clients is a common form of uneven treatment that may seem innocuous, yet it carries the risk of distorting the therapeutic relationship. Gifts can subtly shift the power dynamics, leading to potential favoritism or a sense of obligation. Additionally, it may elicit feelings of indebtedness or differential treatment, which can adversely affect the quality and effectiveness of care.
- Adverse Idealizing Transference
Adverse idealizing transference (AIT) occurs when a client excessively idealizes their therapist, attributing unrealistic positive qualities to them. This may be a result of a mental health condition such as Post Traumatic Stress Disorder (PTSD) or a specific personality disorder and requires therapists to engage with their client’s unique perspectives.
Understanding AIT can be essential as it can lead to an unhealthy dependency on the therapist and hinder the client’s journey toward self-empowerment and autonomy. With such an idealization, the therapist’s role could inadvertently shift from being a guide to becoming a crutch, which may impede the client’s progress toward self-reliance.
Moreover, if therapists encourage this dependency, whether consciously or unconsciously, it could exacerbate the situation, leading to a potentially harmful therapeutic relationship. According to studies, reinforcing dependency can skew the power dynamics in the therapeutic process, creating an environment where the client feels unable to navigate their emotional world without the therapist’s constant presence.
This type of relationship can be counterproductive to the fundamental goal of therapy, which is to equip clients with the tools and understanding to manage their emotions and challenges independently. Therapists must strive to maintain an environment that promotes growth, independence, and resilience rather than dependency or helplessness.
How To Avoid Boundary Violations
Boundary violations between therapists and clients may lead to harmful consequences for both parties involved. While boundary violations are necessary to understand, it can be equally important for practitioners to avoid creating an environment that is too strict. Studies have shown that excessive harshness within the therapeutic setting may lead to an environment that alienates clients and results in unempathetic care.
Many practicing therapists understand the main behaviors and tendencies that are known to be unethical. However, it can be important to recognize that it is often in the gray area where common problems occur. Each client that a therapist serves may create unique circumstances under which boundary violations must be assessed. According to leading studies, researchers note the importance of therapists in clinical practice engaging in thoughtful decision-making practices tailored to each client in order to determine if their actions may constitute a boundary violation or a boundary-crossing.
- Be Mindful Of Conflicts Of Interest
Conflicts of interest in clinical practice are often the main consideration for all forms of interaction and boundaries within the therapeutic relationship. Such conflicts may arise when a therapist’s personal, professional, legal, or financial interests potentially compromise their professional discretion and impartial judgment. It can be essential for therapists to recognize these conflicts and the ways they can skew the decision-making process, leading to potential harm to the client or a violation of professional boundaries.
These conflicts can interfere with the exercise of professional discretion and impartial judgment, consequently compromising the therapeutic process. For instance, a secondary relationship with a client, such as a business partnership or friendship, may cloud the therapist’s judgment and cause them to overlook critical issues or adopt a biased viewpoint.
Similarly, financial conflicts can lead to inappropriate decisions, such as extending therapy beyond what is therapeutically necessary or creating harmful dependency. Therapists must strive to practice self-awareness and implement their best judgment to mitigate these conflicts and uphold the integrity of the therapeutic relationship.
In one study, researchers reviewed current existing literature to develop an overview of boundary violations and the types of factors mental health professionals should consider. In their review, they explain how boundary issues may arise from:
- The manner of scheduling different clients
- The time, place, and location of therapy sessions
- The use of private phone communication
- Social meetings outside of therapy
- Gift giving
- Clothing attire worn during therapy sessions
- Type of language used in sessions
Importantly, they also note that clinical decision-making should be based on what is best for the patient and that the physician’s ideology should be separate from these decision-making processes.
- Be Mindful Of Biases And Patterns
Mindfulness and reflection can be invaluable tools in the toolkit of a therapist, significantly contributing to the quality and efficacy of clinical practice. Through mindful decision-making, therapists may be more equipped to recognize the unconscious biases or patterns that might be inadvertently affecting their therapeutic relationship with their patients. This process can help therapists understand their own reactions and emotions in response to patient interaction, thereby promoting a more objective and centered approach to counseling.
Reflection involves a thoughtful consideration of one’s own experiences to gain insights and improve future performance. This practice may be particularly beneficial in the therapeutic setting, allowing therapists to evaluate their approach, identify areas of bias, and adjust their methods accordingly. By regularly reflecting on their notes and interactions with patients, therapists can ensure their care is attuned to each person’s specific needs.
Boundary Crossing And Boundary Violations
Understanding the distinction between boundary crossings and boundary violations can be paramount in therapeutic settings. Boundary crossing refers to any deviation from traditional therapeutic procedures that may potentially benefit the client. For instance, this may include scheduling an extra session during a crisis or momentarily sharing personal experiences to enhance therapeutic rapport. These actions may foster connection when used sparingly and appropriately, but they must be carefully navigated to avoid any potential harm.
According to professional psychology research, boundary violations refer to “a departure from an accepted practice that places the client or the therapeutic process at serious risk.” Boundary violations are often exploitative and in the best interest of the provider rather than the client. Additionally, boundary violations are likely to take advantage of the client’s dependence and trust and may lead to client confusion relating to their progress, independence, and mental health needs.
Questions To Guide Decision Making
To help guide decision-making surrounding boundaries, it may be helpful for therapists to consider reviewing the following framework and providing answers to each question:
- Are there cultural factors present that may affect client interpretations?
- Does the proposed action align with your treatment strategy and the client’s treatment goals?
- Are your planned actions cultivating independence for the client or is it creating more dependence on therapy?
- Is all the rationale for decision-making and resulting impacts on the client being documented?
- Are the motivations for taking these actions unbiased and evidence-based?
In the event of potential bias, relationship concerns, or any other form of potential violation, it may be worthwhile for therapists to consider transferring care to a different practitioner.
Boundaries In Online Therapy
Online therapy offers an accessible and personalized approach to therapy that may enable improved access to care for those in need. Many individuals seeking treatment avoid doing so due to a fear of in-person interaction and the presence of mental health conditions such as depression and anxiety. Online therapy may provide a comfortable and discreet environment where individuals can feel safe when sharing their thoughts and feelings, potentially leading to more open communication and positive progress.
Online therapy through platforms like BetterHelp has emerged as a valuable tool for therapists, allowing them to extend their reach and provide vital mental health services to those who may be hesitant or unwilling to engage in traditional in-person therapy. However, despite the digital nature of this intervention, therapists must still maintain an awareness of professional boundaries. Missteps—even in the digital setting— can inadvertently damage the therapeutic relationship and impede the effectiveness of therapy.
In one study, researchers assessed the utility of online therapy for therapists and its ability to offer the same level of effectiveness as in-person treatment. In their study, they found that online therapy is just as effective as in-person sessions. Additionally, they discovered that therapists often require additional training on setting boundaries and addressing unique ethical concerns in the digital setting. This study further illustrates the importance of regularly considering the role of boundaries in the unique context of each session and with each individual client.
Takeaway
For therapists, maintaining the integrity of the therapeutic relationship is of utmost importance. It can be crucial to respect and uphold professional boundaries to foster a safe environment conducive to healing and growth for clients. While it may be difficult to strike a balance between being empathetic and compassionate yet professional within client interactions, learning more about common boundary violations can be helpful. To minimize the risk of boundary violations, therapists may consider the nature of their relationship with their clients, the presence of potential biases, as well as the manner in which they deliver treatment strategies based on the client’s current perspectives. Whether you’re delivering support in person or online, staying cognizant of the potential factors affecting the therapeutic relationship can be crucial in offering effective care.
