Boundary Crossing in Therapy

Unethical Decisions: Psychological Professionals

A lack of boundaries between a client and therapist is not simply of concern because it is a technical violation due to ethical or legal concerns. It is a violation of professional trust. A client must feel safe enough to be candid and trust the professionalism of his or her therapist, including the therapist’s willingness to maintain distance. Clients who may be struggling with psychological issues may have some emotional challenges separating therapeutic, professional, and personal relationships. It is incumbent upon the therapist to set boundaries about when to contact the therapist, and therapist-client responsibilities.

The most obvious and egregious reason for ethical violations is that of sexual violations (Aravind, Krishnaram, & Thasneem, 2012). Inappropriate exploitation of a client’s vulnerabilities in such a manner are a clear violation of the therapeutic principles of beneficence, autonomy, and nonmaleficence (Aravind et al., 2012). Compassion is also another core principle, but therapists must not confuse this with being demonstrative to the client in a way that may be mistaken for a sexual overture. Other times boundary crossing may be more ambiguous, however, when the requirements to uphold these values may be blurred with conventional professional activities.

For example, a therapist might set a boundary with a borderline personality disordered client not to call the therapist after a certain hour, given the client’s abandonment issues and the need for the client to learn to function without constant outside reassurance. But this might be viewed in conflict with the legal obligation to report the client’s danger to self or others, if the client has self-harm issues. Also, certain types of clients may be more vulnerable to negative fallout caused by boundary problems than others. “Boundary crossings with certain clients, such as those with Borderline Personality Disorders or those who are acutely paranoid are not usually recommended” since the patient’s difficulty with boundaries even in the best of circumstances is a symptom of the disorder (Zur, 2018, par.13). But these clients are often the most vulnerable to engage in self-harm.

A more benign boundary crossing might occur when, for example, a therapist working with a client on a client’s phobia might accompany a client to an airport before going on a feared short flight (Zur, 2018). Other examples of boundary crossing less clearly tied to therapy might include a therapist dealing with a client with an eating disorder sharing a meal with a therapist, or a therapist working with a child permitting a child to take home a toy as a gift (Zur, 2018). Here, the line between therapy and friend becomes more ambiguous, as well as the boundary between home and office space. The idea that all boundary crossings must be avoided may not be realistic, so long as the client’s needs are placed first and foremost. Therapists may extend the client’s hour without compensation if the therapist feels it is necessary, while still observing legal and professional boundaries, to honor the need for beneficence or compassion.

Another potential area for boundary crossing is that of dual relationships. Particularly in small communities, schools, or the military, engaging with clients in non-therapeutic settings may be required. It can be argued that encounters for example, at a gas station or in the cafeteria normalize the professional client-based relationship. “Non-sexual, non-exploitative dual relationships and familiarity between therapists and clients are not only normal but, in fact, increase trust” (Zur, 2018, par.8). According to such thinking, these interactions reinforce the boundary, rather than collapse such boundaries.

One of the most common reasons for unethical violations regarding boundary crossing is the fact that these boundaries are so unclear. Therapists are guiding clients through situations which occur in normal, human life, such as social relationships, and the obligation to behave with kindness and foster reassurance and trust can conflict with the reassurance and trust that the relationship will remain professional and distanced. Particularly with non-sexual relationships, such as friendly and professional interactions outside of the therapist’s office, boundaries can become blurred.

Conflicting legal and ethical boundaries further complicate this question of appropriate boundaries. The need to maintain proper distance from the client may conflict with the ethical obligation not to abandon the client during a high-stress situation. A school therapist who intervenes by visiting a child in a home situation may have a legal obligation to prevent abuse, but this can also create a conflict between the therapist’s relationship which must be confined by the rules set by the school. Ideally, remaining in contact with legal authorities when there are potential obligations under the law or legal stipulations placed upon the therapist’s behavior, and continuing with professional education to remain abreast of changing professional standards, is imperative to minimize the potential such conflicts may arise.