A research study done in 1997 by Johnston and Farber summarizes a conservative view of boundary violations from a therapist to a client. The researchers state that boundary violations include:
- communication of therapist’s intrapsychic conflicts to the patient
- contamination of the transference and consequent interpretations
- the dissolution of the therapeutic “hold”
- the possibility of inappropriate gratification resulting from counter-transference problems
When a therapist communicates his most intimate thoughts, feelings, beliefs, or behaviors to a client in a therapy session or therapy relationship, the therapist has crossed a professional boundary. However, it is important for all clients to carefully consider the situation because some therapists share details about themselves to develop rapport. Such an incident is known as self-disclosure. Some self-disclosure is good for building a long-lasting relationship with commonalities. But there are those therapist-client relationships that cross the line and end up making the client the therapist and the therapist the client.
Some individuals believe that transference (when the client begins viewing the therapist outside of his or her professional role) and counter-transference (when a therapist reciprocates feelings of the client) can occur in which a therapist has crossed boundaries, making it difficult for a client to benefit from the transference because the therapist simply enjoys the confusion. Freudians or psychoanalysts believe that transference can be a useful tool for helping both therapist and client evaluate feelings, thoughts, and past relationships. If this is not done properly, the client can be manipulated or violated.
There are a lot of signs of a bad therapist, but ethical violations can be very difficult to spot. So I recommend clients look for:
- Violation of Confidentiality: Confidentiality is your legal and moral right to protection of your conversations in therapy, your files, your phone calls, your emails, and other types of information shared about your personal life. There are instances in which therapists may have to discuss your case with:
- interns (students studying for their professional degree),
- supervisors (people with more experience in the field),
- lawyers (if a legal case is pending), police (if they request a warrant to search records), or
- teachers (if a child or adolescent is in the process of getting an IEP or Individualized Education Plan)
- Violation of HIPAA: HIPAA is the Health Insurance Portability and Accountability Act of 1996. This law was passed to protect all medical and mental health information from “outsiders.” But some people claim the ACT has not stopped their employers, lawyers, etc. from requesting information on a psychiatric file. An ethical therapist will make sure that he or she protects the clinical records of clients. Therapists who do not make their policies clear on how they work with HIPAA regulated files, be sure to ask in advance.
- Socializing with clients: It is a common rule that therapists think hard and long about socializing with their clients. Some therapists accept invitations to graduations, weddings, or even funerals. It is up to that therapist whether he or she will accept invitations. However, if a therapist chooses to attend, such events should be once in a lifetime and not frequent occurrences. Socializing with a client can reduce relational respect and professional boundaries.
- Text or email: Some therapists allow clients to text or email them, while others text and email their clients. This can become a really big violation because clients may interfere with the personal lives of therapists or therapists may interfere with the lives of their clients. Either way, for me, email is for office hours only and for certain things. Texting is out of the question! But different therapists do different things. Frequent texting or emailing should be a red flag.
- Sexual misconduct: Believe it or not, some therapists end up abusing their power by taking advantage of clients. Some clients flirt with their therapists and therapists reciprocate. Some therapists come on to their clients. Either way, this is a great ethical and legal violation that can lead to total career loss and thousands of dollars in legal fees.
Ethical and legal boundaries are very difficult for clients and even therapists to understand or implement because there is a lot of gray. There are no black and white answers or perfect ways of doing anything in therapy. But there are common sense ways to protect everyone involved.I believe it is acceptable to develop a “friendship” within the proper bounds with clients. It is okay to use self-disclosure in appropriate moments. It is acceptable to let our guard down as therapists in the appropriate moments. It is only when boundaries are violated, client or therapist is disrespected, personal details become too personal, and danger can result that trouble is likely.
You want to keep an eye out for therapists who walk over their clients, either blatantly or subliminally.If you would like to read the complete article of the study I cited at the beginning, click here for a an online overview of the article.
For more recent research on ethical boundaries, visit the American Psychological Association: article 1 & article 2.
As always, feel free to post your experiences or the experiences of a loved one. Let’s discuss and learn!
All the best