Boundary “Crossing” or Boundary “Violation”?

Ethically, What Is The Difference?

Ethics writers are asking us to make a distinction between a benign non-sexual “crossing” of boundaries and a harmful unethical “violation” of boundaries in client relationships. What are the ethical and clinical implications of that distinction? Where should we draw the line? Who gets to decide?

OUTLINE

INTRODUCTION: Clarifying Terms & Defining the Issues

I. Ethical Standards About Boundaries in Clinical Relationships

II. Professional Recommendations About Boundaries

III. Practical Boundary Issues

A. Boundaries About Time & Place

B. Understandings About Confidentiality & Disclosure

C. Verbal Content Boundaries (incl. Therapist Self-Disclosure)

D. Physical Contact Boundaries (Erotic & Non-Erotic)

E. Gifts

F. Invitations

G. Promises

H. Other

IV. Assessment Tools

V. Ethical Decision Making About Boundaries

A. Assessing Ethical Implications

B. Assessing Clinical Implications

C. Assessing Risk to Client

D. Assessing Risk to Clinician

VI. Staff Training About Boundaries With Clients

Educational Goals:
(a) List five types of boundaries that should be monitored in clinical relationships;
(b) Define “boundary crossing” and “boundary violation” in those areas;
(c) Describe how you might assess boundaries in clinical relationships in your own setting;
(d) Describe some of the types of issues that might arise about staff boundaries with patients.