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Setting Clear and Ethical Boundaries with Clients

Section 6
Clinical Judgment

Question 6 | Test | Table of Contents

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Now let's look at your value system, and how it defines your behavior, and your relationship with your clients. As you know, to effectively set boundaries you must avoid judging your clients' attitudes and behavior. These judgments are usually made according to your own personal value system. However, this seemingly all too obvious statement, about judging your clients, oftentimes creates a dichotomy and is easier said than done. An example of this may be found in public assistance staff that are administering financial aid to people who they feel are less than needy or "deserving."

Another example of the personal values-versus-objectivity conflict is often found in the controversy that continues to exist about the ultimate treatment goal for substance-using clients. Some argue that it is not clear whether no use or controlled use should be the treatment goal.

Here, if this area is one for which you have strong feelings, maintaining the ethic of client self-determination, and maintaining a boundary regarding your personal values can be a challenge. I have a colleague who has become sober through 12 step programs. Thus this colleague feels strongly that no use is the ultimate goal for him, personally. However, he periodically struggles to avoid making personal judgments and maintaining a boundary with clients who set a goal for controlled use.

♦ Are You Imposing Your Own Middle-Class Values?
Also, there is the frequently heard accusation that therapists tend to impose their own middle-class values on their clients. These middle-class values are generally seen as values related to cleanliness, conformity, hard work, and sexual behavior.

However, as you know, sometimes in order to survive, clients whose values run contrary to those of the larger society need to adopt a different way of living. The effective therapist cannot force or impose changes that will result in embracing middle-class values. However, society often imposes the need for change upon the client. The therapist's role is to help the client assess the nature of this change imposed by society. The therapist's role is also to help the client to decide how to adapt these imposed changes in a way that is not self-destructive.

For example, in child custody, there is a need to provide adequate child care. What is "adequate" is sometimes determined between you and the court, and the parents are left with adapting to perhaps the middle-class values that are imposed. In the case of an elderly Alzheimer's patient who enters the hospital with burns from a kitchen fire, society is left imposing a hard decision upon the family as to relocation to a safer environment.

As you know, the mental health professional must have sufficient self-awareness to be able to differentiate between value changes that are essential for a client's good social functioning, or merely value changes that are dictated by the therapist's own personal value system. Those values are so internalized that you are often unconscious of the reasons for adopting these values and using them as a basis for judging effective behavior. A good example of this is found in old social agency records that are filled with notations of home visits in the morning where the mother is, "still in her nightgown with the breakfast dishes unwashed, and is drinking coffee, smoking, and watching TV." The middle class value imposed here is that she is sloppy, dirty, and a poor mother.

Four Ground Rules for Avoiding Judgements
Thus, to effectively set boundaries and avoid judgments, let's look at four basic ground rules for avoiding judgments:

♦ 1. Just remember, you are a walking system of values, so to speak, which is so much a part of you that you are probably not aware of your value system's existence, even though you have considerable feelings about the rightness of these values. For example, ask yourself: What has been my personal experience with substance use and abuse in my family and relationships? What has been my personal experience with physical abuse? With suicide? What are my biases and how does this effect violating a boundary with a client regarding self-determination and judgments?

♦ 2. A useful tool to avoid making judgments is to increase sensitivity to your self-talk and your use of the term "they" or "them." By this I mean, for example a statement like, "They always wear bright clothes and talk too loudly." The use of "they" does not support the client's family values. In this day and age when racial equality "is a given," I was shocked to overhear two teachers talking in the school lounge at lunch. One stated, "Black parents always give their children the oddest names." They proceeded to chuckle over several examples. At that point the one black teacher in the lounge got up and left. The teachers continued to talk with the use of "they" and "them."

However, the teachers were unaware of the racial separation they were creating. They were also unaware of the significance of the black teacher leaving the lounge and that anything could be amiss. Having a renewed awareness of your use of this or other separation terms is having taken the first step toward renewing and re-examining your biases. This renewed awareness should assist you in setting more effective boundaries with your clients.

♦ 3. Regarding avoiding judgments, evaluate yourself and your values as objectively and rationally as you can. Look at the origins of your values and the purpose they service. Take the complex issue of self-disclosure for example. Therapists generally agree limited, superficial self-disclosure can be therapeutically beneficial. However, think about the last session in which you used self-disclosure. At what point would the information to be shared have violated the boundary of meeting the client's needs, but met yours?

♦ 4. Differentiate between values which dictate personal style of living and those which leave clients "freedom to step to the tune of a different drummer." That is, if your client's "stepping to a different drummer" meets his or her needs and is not destructive. If a client arrives for the initial session or a subsequent session under the influence of alcohol or other drugs, the session is usually rescheduled. But, what if the client threatens harm to himself or others? Where do you set this boundary?

- Butheil, T. (1999). The Concept of Boundaries in Clinical Practice; theoretical and risk-management dimensions. American Journal of Psychiatry, 188(96).
Reviewed 2023

Peer-Reviewed Journal Article References:
Bhatia, S. (2017). Conflict and bias in heuristic judgment. Journal of Experimental Psychology: Learning, Memory, and Cognition, 43(2), 319–325.

Harris, K. A., Spengler, P. M., & Gollery, T. J. (2016). Clinical judgment faith bias: Unexpected findings for psychology research and practice. Professional Psychology: Research and Practice, 47(6), 391–401.

Magnavita, J. J., Levy, K. N., Critchfield, K. L., & Lebow, J. L. (2010). Ethical considerations in treatment of personality dysfunction: Using evidence, principles, and clinical judgment. Professional Psychology: Research and Practice, 41(1), 64–74. 

Sah, S., & Feiler, D. (2020). Conflict of interest disclosure with high-quality advice: The disclosure penalty and the altruistic signal. Psychology, Public Policy, and Law, 26(1), 88–104.

Spengler, P. M., & Pilipis, L. A. (2015). A comprehensive meta-reanalysis of the robustness of the experience-accuracy effect in clinical judgment. Journal of Counseling Psychology, 62(3), 360–378.

Weinzimmer, L. G., Dalstrom, M. D., Klein, C. J., Foulger, R., & de Ramirez, S. S. (2021). The relationship between access to mental health counseling and interest in rural telehealth. Journal of Rural Mental Health, 45(3), 219–228.

Wilson, J. L., Uthman, C., Nichols-Hadeed, C., Kruchten, R., Thompson Stone, J., & Cerulli, C. (2021). Mental health therapists’ perceived barriers to addressing intimate partner violence and suicide. Families, Systems, & Health, 39(2), 188–197.

QUESTION 6
What is a good exercise to increase your self awareness of your values system? To select and enter your answer go to Test.

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