Boundaries must be put in place in order to maintain a healthy professional relationship
Like all healthcare professionals, mental health workers such as therapists and psychologists must also follow a set of ethics that dictate the relationship they have with their patients. Equally important as the ethics of client confidentiality is the principle of setting up parameters for contact. Mental health professionals must decide if and when to take phone calls from patients, whether they’ll acknowledge them in a public setting and if it’s appropriate to give them a reassuring hug or handshake after a session.
Creating these boundaries can serve as a matter of convenience for the therapist. For example, psychologists may place limits on what times a patient can call their personal cell phone so as not to disrupt family mealtime.
These parameters, however, are ultimately put in place to serve the patient. When a patient has a sick family member in the hospital, his therapist may deem it acceptable to show the client compassion by visiting that relative in the hospital or sending flowers. This is what the American Counseling Association defines as “extending counseling boundaries” because it involves extenuating circumstances. In its 2014 Code of Ethics, the organization outlines that professional precautions should be taken in these types of situations and should be documented.1
Sometimes a therapist may decide that a thoughtful gesture or contact outside of a therapy session is not in the best interest of the client. This may be the case if a patient is in therapy because he is trying to cope with a relative’s chronic illness or even the potential for a loss, which places the patient in an extremely vulnerable position. “Treatment Boundary Violations: Clinical, Ethical, and Legal Considerations,” a paper published in the Journal of the American Academy of Psychiatry and the Law Online, explains that patients who have been physically or sexually abused as children are also increasingly vulnerable.1 This is because they’re more likely to have a skewed idea of appropriate relationships given the fact their personal boundaries weren’t respected at a young age.
When boundaries are not put in place, the relationship between therapist and client then runs the risk of causing more psychologic issues for the latter. Patients who have borderline personality disorder, for example, are very sensitive to the way others treat them. The American Psychiatric Association explains that these patients may misinterpret certain reactions as hurtful, like a therapist not answering a phone call.2 People with this disorder often have rapidly changing perceptions of their body image from extremely positive to extremely negative; therefore, a mental health professional would refrain from complimenting such patients on their physical appearance or attire.3
Boundaries are essential to achieve healthy and appropriate relationships, not only between a patient and therapist but also for every professional and personal relationship.
1. American Counseling Association. 2014 ACA Code of Ethics. https://www.counseling.org/resources/aca-code-of-ethics.pdf
2. Journal of the American Academy of Psychiatry and the Law Online. 1992. Treatment Boundary Violations: Clinical, Ethical, and Legal Considerations. http://www.jaapl.org/content/20/3/269.full.pdf
3. American Psychiatric Association. 2001. Borderline Personality Disorder. https://www.jpshealthnet.org/sites/default/files/borderline_personality_disorder.pdf