Boundaries in a healthy counseling relationship are not boundaries you can see, like a white stripe on the highway telling you not to cross over that line to avoid danger. They are invisible boundaries but can be just dangerous if crossed.
To most people, having healthy boundaries in a counseling relationship comes naturally. It makes common sense for most people that they should not have sexual relationships with their clients, they should not be friends on social media with their clients, and they should not be giving them rides home, or giving them gifts. Yet, for some therapists, this is still an issue, and boundaries are crossed and violated every day.
Some examples of boundary crossings that have made news headlines include a therapist and client falling in love, therapists falsely billing clients for sessions they did not have, and even therapists meeting clients in public places like Starbucks which violates every privacy right due the client.
All of these are completely inappropriate and can harm the client who may too vulnerable and weak at the time to understand they are being abused in the client-counselor relationship. It would be rare for a counselor to be a victim since all counselors are trained in the areas of ethics and know exactly where boundaries should be set.
It is important for clients to know these boundaries as well so they can gauge the relationship they have with their therapist, making sure it remains legal and ethical. And if not, clients need to know how to report such violations.
Therapeutic Relationship Defined
A Therapeutic relationship is a close relationship between at least two people in which one person, the therapist, is helping an individual, the client, change his or her life for the better. Elements to a therapeutic relationship include the therapist remaining supportive no matter what the issues are of the client. The therapist also needs to forego any judgments of the client and treat the client with empathy, understanding and acceptance. Furthermore, providing a safe environment and consistent time limits can help build the counseling relationship.
Phases of a therapeutic relationship include the orientation phase, identification phase, working phase and the resolution phase. The orientation phase is when the client and therapist get to know one another and when the relationship-building process begins. While there will be paperwork completed during this phase, there will also be a lot of general talk and general questions and answers regarding the client’s personal and professional life. The questions will be related to more surface level information that may include minor details about family and friends, work, hobbies, and commonalities between therapist and client, without having the therapist self-disclose too much of their background. This phase allows the client to ask questions such as background of the therapist, counseling style, diagnoses, medications and anything else the client has a concern with regarding the counseling process. It is here that trust building takes place, as well as role clarification, informed consent, and the counseling structure are clarified.
The identification phase gets into more specific details regarding the problems the client states he or she is having and what brought them into counseling. This can also be defined as the assessment and diagnosis phase. Here the therapist will determine if the client is at a risk for harm, either from self or others. The therapist will also complete psychological testing or any other paperwork that will help form a diagnosis. Goal setting with the client should also take place during this phase, guiding the client in setting positive and realistic goals that will lead them to success. Some general positive goals that clients need are to improve coping skills, improve decision making skills, and build better relationships. Once the general goals are set, the client can begin to set more specific goals such as finding a job and the steps to follow. A treatment plan can be established in this phase, laying out the goals and giving a deadline to those goals.
The working phase involves implementing the treatment plan. It is time for the client to start taking actions towards achieving their goals. If a client needs to leave an abusive household for their own safety, they can start making progress towards that goal by completing specific tasks. If a client needs to confront someone, the therapist can role play the confrontation with them to help the client build confidence and assertiveness. If a client needs to quit using drugs, this is the time to implement steps such as going to detox or rehab.
The resolution phase is where the therapist will begin the termination process with the client. Helping the client find closure and helping them find their independence outside of therapy is a must. Through each and every therapeutic phase it is necessary to have clearly communicated boundaries between therapist and client.
The Need for Boundaries
There is a need for clear boundaries to protect the therapeutic process and to keep the relationship professional. Boundaries protect clients from getting taken advantage of due to vulnerability. Boundaries also protect therapists from being sued by patients. In some ways, the client automatically trusts their counselor as an authority figure. Although they may not trust them with all of their secrets right away, there is a level of trust that the therapist is not going to harm them. Therapists know this and should take extra steps to let the client know they will not take advantage of that trust and confirm they will do everything in a manner that is beneficial to them getting help. Therapeutic boundaries are of significant importance because it makes the client feel safe.
Boundaries are based on good decision making skills. Steps to ethical decision making include some of the following:
- State the question or concern clearly and simply to avoid confusion
- Anticipate who will be affected
- Determine who is the client
- Assess if you are the right person to do the job
- Review ethical standards
- Review legal standards
- Review research and history relevant to the situation
- Consider any or all things they may affect ethical judgment
- Develop plan B to decisions
- Think through alternative courses of action
- Document process and results along the way
Types of Boundaries
There are different types of boundaries including boundary crossings and boundary violations. Boundary crossings are not harmful to the client or the client therapist relationship. There are many times when a boundary crossing can actually be beneficial. For instance, a drug abuse therapist may want to disclose certain information about their experience with drug abuse in order to help the addict they are counseling feel like they have a competent and knowledgeable counselor who can offer them hope of success. Boundary violations, however, can be harmful to the client and the therapeutic relationship. Examples of boundary violations include providing more time for one patient than for others; meeting clients in any location other than a professional office; seeing a patient for free or allowing gifts to be exchanged; physical contact of any kind.
Other types of boundaries include physical, emotional and intellectual. In addition, personal boundaries that some clients may have can include rigid, porous and healthy boundaries. Rigid boundaries are described as being detached and unlikely to ask for help. They can seem anti-social and not have a lot of friends, especially close friends. Porous boundaries of clients appear as overly friendly, finding it hard to say no, over-sharing information about them, fearing rejection and seeking approval from others. Healthy boundaries in clients means the counselor offers an appropriate amount of information, feels comfortable with their own decisions, and doesn’t compromise his or her own values.
Healthy Boundaries
Healthy boundaries allow a person to have high self-esteem, be assertive and make good decisions. Healthy boundaries leave a person feeling good after the session. We all have that nagging feeling or instinct that tells us when something is right or wrong. Listen to your instincts and follow guidelines to make absolutely sure no boundary violations are being made. Healthy boundaries are based on five different principles:
- Beneficence is where the therapist recognizes the importance of doing what is best for the client and benefits the client the most. It is an action that is done to benefit the client.
- Nonmaleficence refers to the therapist who avoids any activities that may do harm to the client. This is compared to the Hippocratic Oath of do no harm to the client.
- Autonomy is when the therapist promotes the client being independent from them. Autonomy helps clients make their own decisions.
- Justice is when the therapist gives counseling that is equal and fair and does not show favor.Justice can involve equity, access, participation and harmony.
- Fidelity is being honest and committed to helping the client make progress.
Unhealthy Boundaries
One way to avoid unhealthy boundaries as a professional is to ask yourself the following questions when working with a client:
- How would this be viewed by colleagues, family members of the client, your family and friends?
- Is the client being given special treatment that other clients are not receiving?
- Are you comfortable writing about this in progress notes of the client?
- Does the action benefit the counselor or the client?
Examples of major ethical violations in therapy include self-disclosure when it is given too much from the counselor to the client. Clients do not need to know everything about you in order to have a good therapy session. Information given should be to help the client in their process of healing, not by giving them additional obstacles to overcome. Other violations include transference, counter-transference, violations of confidentiality, texting or emailing too much, and having a sexual relationship with the client. Self-disclosures when you offer the client information about yourself as a counselor that may or may not benefit the therapy process. The context in which the disclosure is made and the intent behind the disclosure are two very important aspects. Transference refers to the feelings and thoughts a client may have towards a therapist. Counter-transference refers to the feelings and thoughts a therapist may have towards a client.
Patients have a right to confidentiality in rehab and should be made to feel confident there information will not be shared with anyone else. There are three situations in which a counselor can break confidentiality legally. One is if the client he or she has threatened harm to self. Another is if they have threatened harm to someone else. And the third is if the counselor is order by a court to supply information.
If a client feels their boundaries have been violated, they should be made aware of the legal processes they can take. Clients can file reports with a therapist’s supervisor or hiring agency. In addition, they can file a report with the Better Business Bureau and the Licensing Board with the state of operation. This should always be done in the cases of violations to prevent further violations with other clients. If a therapist feels they have gone too far in the relationship with a client, they can seek help from their supervisor or other professionals and refer the client to a different counselor.
When in doubt, don’t do it. If there is ever any question about whether or not to do something with a client, wait until you have a clear answer before proceeding. Ask for help from other professionals, get feedback from superiors in the field, and check the legal ramifications of some behaviors. The key is to think first, double check the right response, then act. The client’s health and well-being are far too important. Their mental states are fragile and behaviors can be easily misconstrued. Clear and precise communication, honesty, and knowledge are factors that will enable the therapeutic relationship to succeed.
As a therapist, make sure to set boundaries for a healthy counselling relationship in the beginning stage of treatment so that there is no confusion at any point in the process. Make sure clients know their rights and feel comfortable acting on those rights if necessary. Guidelines are set in place to help all therapists avoid wrong doings, whether intentional or accidental. There is no good excuse for violating a client’s boundaries.