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Boundary Questions in Therapeutic Relationships
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Four Basic Premises
What exactly are boundaries? As you know, boundaries
set limits between you and your client. Your professional Code of Ethics helps
to set these boundaries or limits. This CD will explore the blur or gray areas in these not so clear cut boundaries. The goal, by the end of this CD, is to increase
your self-awareness and perhaps gain a new perspective on setting some client
limits in your therapeutic relationships.
is a two CD series. The first CD in this series will cover: basic premises; attitudes
and behaviors; gender culture; use of defense mechanisms; security vs. growth;
middle-class values; setting session tempo; nonverbal communication; touch; and
acceptance that leads to expectations.
The second CD will discuss the boundaries issues of: self-determination, transference
and counter transference, friendship versus partnership; judgments; setting the
session focus; partialization; advice giving; making promises; confrontation;
manipulation; and referrals.
Four Boundary Questions
The following are four values that constitute the basic premise of the therapeutic
relationship. Let's look at how even the most basic of concepts present boundary
questions. Here is an example of each of the four values:
♦ #1. The
worth of the individual. A basic premise right? Think again. Who determines how
worthy someone is to retain custody of his or her children? When you write your
recommendations to the court, what was the boundary or limit you set in your report
regarding the intensity and frequency of abuse for the "rehabilitated"
parents seeking to regain custody?
The right of self-determination is also a basic ethical premise that raises
boundary issues. Later on this CD we will explore the issue of suicide. However,
with a suicidal client you treated, where did you set the boundary between freedom
and commitment to an in-patient unit?
A third philosophical basis of the therapeutic relationship is the right to share
the benefits of society, but at what point does your client with a substance-related
disorder lose his rights to share the benefits of society? Let's explore this
one further. Some substance-use treatment professionals have criticized the classification
of substance-use disorders by the DSM, Diagnostic and Statistical Manual, as simplistic
and too straightforward.
They have argued that substance use cannot be forced
into the two arbitrary categories of abuse or dependence, but rather that substance
use represents a continuum that ranges from non-use to dependency. With your last
"substance-related disordered client," what criteria did you use to
set a boundary in the gray area of the DSM classification system, which many view
as inadequate, regarding court orders to a treatment facility and depriving the
client of his or her right to benefit from societal freedom?
♦ #4. The mutual rights and responsibility between your client and society is a philosophical
basis of the mental health professions. Now, regarding the boundary between rights
of your client, versus the rights of society...ask yourself...the last time your
client threatened to harm an identifiable other, where and how in your mind did
you draw the limit regarding a need to warn or not warn the other party?
The point to be made here is that, even in the most basic of premises regarding
our mental health profession you are drawing ethical boundaries.
♦ Four Basic Premises Examples
the preceding examples, select one which is most meaningful. Here are the four
basic premises examples again:
1. Your recommendations to the court
for treatment decisions about custody in a child abuse case;
2. Suicide and commitment;
3. Substance abuse; and
4. Duty-to-warn regarding
threats to an identifiable other. Ask yourself
how do I set boundaries with
this difficult issue?
♦ Strategy for Setting Boundaries Effectively with Clients
It has been my experience that I set boundaries
effectively with clients when I feel I am able to gain personal objectivity. How
do I gain this objectivity? By increasing my personal awareness regarding my needs,
weaknesses, and strengths.
"awareness" I mean my ability to deal with my personality patterns and
client issues, as they may relate to my life experience, which may cloud my ability
to relate to the client.
I look at my level of openness. I look at my
ability to be aware of values, attitudes, and patterns of behaving in the groups
of which I consider to be a part. Lastly, I look at my ability to differ and stand
alone when necessary
should I need to act as an advocate for the client.
It is one thing to recognize my shortcomings and another to change them.
Peer-Reviewed Journal Article References:
Drum, K. B., & Littleton, H. L. (2014). Therapeutic boundaries in telepsychology: Unique issues and best practice recommendations. Professional Psychology: Research and Practice, 45(5), 309–315.
Geller, S. M., & Porges, S. W. (2014). Therapeutic presence: Neurophysiological mechanisms mediating feeling safe in therapeutic relationships. Journal of Psychotherapy Integration, 24(3), 178–192.
Summers, F. (2017). Sexual relationships between patient and therapist: Boundary violation or collapse of the therapeutic space? Psychoanalytic Psychology, 34(2), 175–181.
What are four values that constitute the philosophical bases of the
therapeutic relationship that present boundary challenges? To select and enter
your answer go to .