Setting Boundaries In Professional Relationship

In today’s psychology profession, a therapist and even the client can cross many boundaries if immediate boundaries are not put into place during the initial visit. Some boundaries that are crossed are not a problem at first and then the problem progresses. Leonard L. Glass called these, “the gray areas of boundary crossing and violation” (429). However, there is further description, “Boundary issues mostly refer to the therapist's self-disclosure, touch, an exchange of gifts, bartering and fees, length and location of sessions and contact outside the office” (Guthiel & Gabbard). This statement by Thomas G. Gutheil, M.D. & Glen O. Gabbard, M.D explains the meaning of boundary

Hi, Janet! I do believe that all boundaries set for yourself as a case manager should be done through professionalism regardless of whatever situation you find yourself with a client. Janet we do have to be careful

I have been immensely helped by many people, and especially by Deborah Bronnert of the Department of the Environment, to whom I am particularly grateful. But shortcomings or mistakes in this Report are my fault alone. Some recommendations are radical. The participants in the construction process can react in three ways to them. They can refuse to have anything to do with the Report. That would be a pity. The problems would remain, but the goodwill to tackle them, which has been growing dramatically over the last twelve months, would be lost. They can pick out the sections which suit them and reject the rest. If everyone does that, nothing will happen. Or, hopefully, they can try to make the package work, through the implementation structures which the Report recommends. They can set about Constructing the Team. The time to choose has arrived. The construction process cannot wait 30 years for another Banwell or 50 years for another Simon.

I choose to complete my second reflection paper on chapter three: Boundary Crossing in Clinical Practice. The author starts the chapter first by mentioning seeing other professionals engaging in sexual encounters with their clients. She found it hard to understand how a professional could participate in such acts. As the author began to look at boundary she began to see she was also guilty not as heinous as some of her fellow colleagues by participating in sexual acts but unintentionally crossing certain boundaries that she was unaware of.

There are many ways of forming a relationship and gaining the trust and respect of the patient and I had to work out the different things that make a good therapeutic relationship. According to Hinchliff et al (2003) there are a number of important elements that make a good therapeutic relationship, but it is important to make clear that a therapeutic relationship is a formal relationship between a medical professional and patient. The Nursing and Midwifery Council (2008) maintains that at all times nursing staff must maintain appropriate professional boundaries in the relationships they have with patients and clients.

As a healthcare professional a therapeutic relationship is fundamental in providing quality patient care. The Nursing and Midwifery Board of Australia (NMBA) National Competency Standards for a Registered Nurse (2006) emphasises Collaborative and Therapeutic relationships as one of the four main domains which make up the standards. The assignment will explore one specific quality on establishing, maintaining and appropriately concluding a therapeutic relationship in relation to a Horizon Hospital and Health Service client, in this case Mary Young. The specific attribute chosen is ‘establishes rapport with individuals/groups that enhances they ability to express feelings, fosters an appropriate context for expression of feeling.’ This attribute is crucial in having the guiding principals for a safe professional practice.

A counselling relationship is likened to being on a journey - a beginning, middle and end (Smallwood, 2013). During the beginning phase the client develops sufficient trust in the counsellor and the relationship ‘to explore the previously feared edges of his awareness’ (Mearns and Thorne, 1988, p.126).

By working in partnership with professional colleagues, can help to overcome perceived boundaries between services and organisations,

Dual relationships occur when a practitioner is in a professional role with a client as well as taking on another role outside the clinic with the client. The professional needs to assess the risk in the relationship and whether both the practitioner and the client can differentiate between a boundary crossing and a boundary violation. In rural area’s a dual relationship may be unavoidable, the article discuses that the practitioner may have been chosen because of the prior relationship, and that some form of prior relationship may even be a prerequisite for the development of trust and respect in a small community. However, Zur also writes about the “Slippery Slope Effect” in which that all boundary crossings eventually lead to sexual relationships and boundary violations. The author then notes that the slippery slope effect is an unreasonable link and adds that when thinking of crossing a boundary the professional needs to consider the welfare of the client and benefits to treatments, whilst avoiding harm or exploitation and to respect the client’s autonomy (Zur 2004, pp27-32).

Federn (1961) states that individuals separate their internal experience from the external world through psychological boundaries. In addition, these boundaries allow an individual to maintain the distinction between oneself and others (Mahler, Pine, & Bergman, 1975). In the context of therapy boundaries between the therapist and client provide an environment that fosters safety and trust enabling exploration. This dynamic places mental health professionals in a position of power over the client (Simon, 1992). This power differential creates a responsibility for the therapist to create and maintain appropriate, professional boundaries. When speaking about departures from commonly accepted clinical practice it is necessary to distinguish between boundary crossing and boundary violations. Whereas boundary crossing may or may not benefit the client, boundary violations have the potential to seriously harm the client or the therapeutic process (Simon, 1992). It is important to note that either the client or the therapist has the ability to cross or violate boundaries. However, the duty to put the client’s therapeutic care and goals first lay with the clinician alone.

In clinical practice it is wise for mental health professionals to monitor boundary crossing or multiple relationships. These roles have the potential for therapist to use power inappropriately through influence or exploitation of clients. Therefore it is essential to continually monitor the impact of the behavior on clients (Corey et al., 2011). From ethical perspective dual relationships in its self is not a malpractice. The legal aspect depends on the nature of the relationships.

Recognizing hazards in the workplace and setting clear boundaries initially and maintaining them throughout therapy will go a long ways in a therapist “keeping their sanity” intact. It is better to be proactive than reactive in this respect and dismiss the notion that “Boundary issues or countertransference issues won’t affect me.” “Those who understand the etiology and impact of these liabilities are most effective in minimizing their negative consequences, and thus more successfully “leave it at the office” at the end of a long workday” (Norcross & Guy, 2007, p. 36). I believe that all counselors will carry pieces of their clients with them at all times, but remaining aware of the risks and dangers associated with our specific occupation will allow counselors not to be affected as

Boundaries are extremely important in a counseling session. Setting boundaries and limits in therapy sessions represents an ethical decision that is set by each counselor, when entering a therapeutic relationship. In this presentation, I will discuss pertinent boundary issues that the staff has encountered, since working at this agency. Finally, I will describe how these boundaries are addressed and resolved at this site.

When discussing the importance of professional boundaries in mental health work, most people think first of relationships between psychotherapists and clients. However, similar boundary considerations are relevant for professor–student relationships, supervisor–supervisee relationships, consultant–consultee relationships, and researcher–participant relationships. Although different dynamics are at play, the relationships psychologists have with each other, with other professionals, and with the general public have boundaries that warrant ethical consideration as well. The American Psychological Association (APA) offers some guidance. The APA Ethics Code says, in Standard 7.07: "Psychologists do not engage in sexual relationships with

Therapy relationships with clients. The psychologist to patient relationship during therapy is a crucial aspect. It is within ethical guidelines that the psychologist clearly establish his role whether it be with an individual, group, or family therapist. These roles need to be understood for the variety of issues that may arise; one of which is the disclosure of information. Psychologists, for obvious reasons, are not to have sexual relationships with patients or former patients within a