Ethical Boundaries in Psychology: Therapist-Client Limits

The Importance of Professional Boundaries in Therapy

A lack of boundaries between a client and therapist is not simply a concern because it constitutes a technical violation of ethical or legal rules — it is a violation of professional trust. A client must feel safe enough to be candid and to trust the professionalism of his or her therapist, including the therapist's willingness to maintain appropriate distance. Clients who are struggling with psychological issues may face emotional challenges when separating therapeutic, professional, and personal relationships. It is incumbent upon the therapist to set clear boundaries regarding when to contact the therapist and what each party's responsibilities entail.

Sexual Violations and Core Therapeutic Principles

The most obvious and egregious form of ethical violation is that of sexual misconduct (Aravind, Krishnaram, & Thasneem, 2012). Inappropriate exploitation of a client's vulnerabilities in such a manner is a clear violation of the therapeutic principles of beneficence, autonomy, and nonmaleficence (Aravind et al., 2012). Compassion is also a core principle, but therapists must not confuse it with demonstrative behavior toward the client that may be mistaken for a sexual overture. In other cases, boundary crossing may be more ambiguous, particularly when the requirements to uphold these values are blurred by conventional professional activities.

Ambiguous Boundary Crossings and Vulnerable Clients

For example, a therapist might set a boundary with a client diagnosed with Borderline Personality Disorder not to call after a certain hour, given the client's abandonment issues and the need to learn to function without constant outside reassurance. However, this boundary may conflict with the legal obligation to report the client's danger to self or others if the client has self-harm tendencies. Certain types of clients may also be more vulnerable to negative fallout from 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" because the patient's difficulty with boundaries — even under the best circumstances — is itself a symptom of the disorder (Zur, 2018, par. 13). Yet these clients are often the most vulnerable to self-harm.

A more benign boundary crossing might occur when, for example, a therapist working with a client on a phobia accompanies that client to an airport before a feared short flight (Zur, 2018). Other examples of boundary crossings less clearly tied to formal therapy might include a therapist treating a client with an eating disorder sharing a meal with that client, or a therapist working with a child allowing the child to take home a toy as a gift (Zur, 2018). In these cases, the line between therapist and friend becomes more ambiguous, as does the boundary between home and office space. The idea that all boundary crossings must be avoided may not be realistic, provided that the client's needs are placed first and foremost. Therapists may extend a session beyond the scheduled hour without additional compensation if they feel it is necessary — while still observing legal and professional boundaries — in order to honor the principles of beneficence and compassion.

References

Aravind, V. K., Krishnaram, V. D., & Thasneem, Z. (2012). Boundary crossings and violations in clinical settings. Indian Journal of Psychological Medicine, 34(1), 21–24.

Hook, J., & Devereux, D. (2018). Boundary violations in therapy: The patient's experience of harm. BJPsych Advances, 24(6), 366–373. doi:10.1192/bja.2018.26

Zur, O. (2018). To cross or not to cross: Do boundaries in therapy protect or harm. Psychotherapy Bulletin, 39(3), 27–32. https://www.zurinstitute.com/boundaries-in-therapy