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The following article discusses the nature of the professional relationship, provides information to help members recognize potential problem situations, and suggests some strategies to consider in managing professional boundaries.
Characteristics of Professional Boundaries
Boundaries are the framework within which the therapist/client relationship occurs. Boundaries make the relationship professional, and safe for the client, and set the parameters within which psychological services are delivered. Professional boundaries typically include fee setting, length of a session, time of session, personal disclosure, limits regarding the use of touch, and the general tone of the professional relationship. In a more subtle fashion, the boundary can refer to the line between the self of the client and the self of the therapist.
The primary concern in establishing and managing boundaries with each individual client must be the best interests of the client. Except for behaviours of a sexual nature or obvious conflict of interest activity, boundary considerations often are not clear-cut matters of right and wrong. Rather, they are dependent upon many factors and require careful thinking through of all the issues, always keeping in mind the best interests of the client.
Typical Areas Where it May Be Difficult to Draw A Line or Where Boundaries Can Become Blurred
There are a number of areas in which one has to maintain boundaries, that is, draw a line. Below are some typical areas that can present difficulties.
Dual and overlapping relationships. Dual relationships should be avoided. These occur in situations where the member is both the clinician and also holds a different significant authority or emotional relationship with the same person. Examples can include course instructor, work place supervisor, or family member. Members needs to remain cognizant that the purpose of avoiding dual relationships is to avoid exploiting the inherent power imbalance in the therapeutic relationship. Overlapping relationships, while potentially problematic, may not always be possible to avoid. Overlapping relationships, where a member has contact, but no significant authority or emotional relationship with the client, may occur particularly for therapists who are members of small communities, or for clinicians who work with a particular client population with which they are also affiliated. Such overlapping relationships can occur in situations where, for example; the client is a member of a particular religious or ethnic group and tends to practice within this community; the therapist is gay or lesbian and works with gay or lesbian clients; or, the member has a child with a learning disability, is active in a local association, and also does learning disability assessments. Situations where there may be overlapping relationships need to be judged on a case by case basis.
Members should avoid relationships with their clients outside of therapy where either the therapist or client is in a position to give a special favour, or to hold any type of power over the other. For example, some situations to be avoided include employing a client or his or her close relatives, involving oneself in business ventures where one could benefit financially from a client’s expertise or information, or engaging in therapy or assessment with a current student. Similarly, members should refrain from requesting favours from clients, such as baby-sitting, typing, or any other type of assistance that involves a relationship outside therapy.
Becoming friends. Generally, members should avoid becoming friends with clients and should refrain from socializing with them. Although there are no explicit guidelines that prohibit friendships from developing once therapy has terminated, members must use their clinical judgment in assessing the appropriateness of this for the individual client. Potential power imbalances may continue to exist and influence the client well past the termination of the formal therapeutic relationship.
In the course of therapy, some clinicians, on occasion, may engage in activities that resemble friendship, such as going on an outing with a child or adolescent, or attending a client’s play, wedding, or special event. In all cases it is the clinician’s responsibility to ensure that the relationship remains therapeutic and does not develop into a friendship or a romantic involvement. The definition of "sexual abuse" within the legislation makes it clear that it is unacceptable to date a current client. Since power imbalances may continue to influence the client well past termination, professional standards prohibit a member from engaging in a sexual relationship with a former client to whom any professional service was provided in the past two years. Members are reminded that even the most casual dating relationship may lead to forms of affectionate behaviour that could fall within the definition of sexual abuse.
Physical contact. There are a variety of ways of using touch to communicate nurturing, understanding and support such as a pat on the back or shoulder, a hug or a handshake. Such touch can however, also be interpreted as sexual or inappropriate which necessitates careful and sound clinical judgment when using touch for supportive or therapeutic reasons. Clinicians must be cautious and respectful when any physical contact is involved, recognizing the diversity of cultural norms with respect to touching, and cognizant that such behaviour may be misinterpreted.
Diagnostic and therapeutic work with children requires special consideration. Some agencies or institutions for example, advise their staff to avoid any touching of children. In other settings however, touching may be permitted, and this would ordinarily be open to public scrutiny. In working with children and considering the question of touching, one might ask, "Would I do this in the presence of my colleagues or this child’s parents?" Again, good clinical judgment should prevail for the protection of both the client and the practitioner.
Some clinical situations such as neuropsychological testing and biofeedback, or clinical interventions such as bioenergetics, require touching the client. When such touch is necessary, it is important to explain this to the client and ensure the client’s understanding, and the client’s fully informed consent. If there is concern that a particular client may misinterpret a therapist’s actions, members may wish to have someone else present in the session, consider an alternate treatment approach, or think about a referral to another practitioner.
Century Massage & Bodywork, Inc.
- Lyn Yancha, LMP
425.228.5217
www.CenturyMassage.com
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