Boundary violations: Do some contended standards of care fail to encompass commonplace procedures of humanistic, behavioral, and eclectic psychotherapies?

Abstract

Hugging, dining with, self-disclosing to, or making house calls to patients are among behaviors which have been termed "boundary violations" in psychotherapy. Although authors have asserted that boundary violations are both harmful and beneath the standard of care, some of the activities in question are consistent with the ethical practice of humanistic and behavioral psychotherapies, as well as with eclectic approaches deriving from those schools. Theoretical statements, survey research, and case examples are used to elucidate concerns about maintaining metaphorical boundaries in psychotherapy and to demonstrate that psychotherapy is diverse with respect to the behaviors at issue. It is concluded that even scrupulous humanistic, behavioral, and eclectic practitioners might appear to practice negligently by virtue of engaging in behaviors which some consider to be boundary violations and that innovative practice might be stifled by riskmanagement concerns. The Logic of Boundary ConcernsSeveral authors have contributed arguments which emphasize the importance of maintaining boundaries in psychotherapy (

Mentoring, boundaries, and multiple relationships: opportunities and challenges

“…In contrast to this slippery slope perspective, other authors have recently argued that while avoiding boundary crossings may in fact prevent boundary violations from occurring, avoiding all boundary crossings (and all multiple relationships as a result) also has the effect of withholding from others much of what makes the professional relationship the rich, rewarding, and valuable relationship that all hope it to be (e.g., Barnett & Yutrzenka, 1994;Lazarus, 1994;Williams, 1997;Zur, 2001). Additionally, there is no empirical evidence suggesting that the crossing of boundaries always heightens the risk of boundary violations (Lazarus, 1998).…”

“…Additionally, there is no empirical evidence suggesting that the crossing of boundaries always heightens the risk of boundary violations (Lazarus, 1998). While that possibility exists, with appropriate attention, forethought, and open discussion by both parties, boundary violations may be prevented and avoided while engaging in boundary crossings that enhance and enrich the mentoring relationship (Barnett, 1999;Williams, 1997).…”

Wilderness Therapy: Ethical Considerations for Mental Health Professionals

“…The current professional climate emphasizes a movement toward more clearly delineated boundaries (Lazarus 1994;Williams 1997). Although there are certainly times when clearly defined boundaries are appropriate and essential, Lazarus (1994) suggests that this trend parallels professional anxiety around the fear of malpractice suits and may undermine clinical effectiveness.…”

Superficial supervision: Are we placing clinicians and clients at risk?

“…Professional boundaries, therapeutic relationships and the underlying ethics and principles that inform each discipline's understanding of the professional boundary are consistently reported in the literature (Gabbard, 1999;Lamb & Moorman, 1998;Martinez, 2000;Nadelson & Notman, 2002;Scopelliti et al, 2004;Strom-Gottfried, 1999;Williams, 1997). Mental health clinicians recognise that professional boundaries provide the limit of the therapist/client relationship, as well as providing a 'safe space' for the interaction between the therapist and the client.…”