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Setting Clear and Ethical Boundaries with Clients

Section 1
Therapeutic Boundaries

Question 1 | Test | Table of Contents | Introduction

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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 course will explore the blur, or gray areas, in these not so clear-cut boundaries. The goal, by the end of this course, is to increase your self-awareness and perhaps gain a new perspective on setting some client limits in your therapeutic relationships.

This is a two course series. The first course 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 course 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 a 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?

♦ #2. The right of self-determination is also a basic ethical premise that raises boundary issues. Later in this course 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?

♦ #3. 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
From 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.

By "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 myself 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.

- Stone, M. (1999). Boundary Violations between Therapist and Patient. Psychiatric Annals, 670(7).
Reviewed 2023

Peer-Reviewed Journal Article References:
Brend, D. M., Krane, J., & Saunders, S. (2020). Exposure to trauma in intimate partner violence human service work: A scoping review. Traumatology, 26(1), 127–136.

Carsky, M. (2020). How treatment arrangements enhance transference analysis in transference-focused psychotherapy. Psychoanalytic Psychology. 

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. 

Wu, K. S., & Sonne, J. L. (2021). Therapist boundary crossings in the digital age: Psychologists’ practice frequencies and perceptions of ethicality. Professional Psychology: Research and Practice.

QUESTION 1
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 Test.

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