Professional boundaries are an essential component of the therapeutic setting. It is imperative that all licensed mental health professionals including Marriage and Family Therapists (MFT), Psychologists (PhD or PsyD), Licensed Clinical Social Workers (LCSW), and Licensed Professional Clinical Counselors (LPCC) establish and maintain appropriate professional boundaries to protect themselves legally, ethically, and professionally. Mental health professionals must understand the difference between clinically useful boundary crossings versus unethical or illegal boundary violations. A practitioner’s boundaries may also be further defined by a therapist’s school of thought.
Consider the following fictionalized vignette:
Diane, a therapist, is a licensed MFT in California in private practice. Her client, Lisa (her client) begins to cry in session while discussing her mother’s imminent death. Lisa’s relationship with her mother has been a primary therapy topic. Lisa asks Diane if they can continue their session outside on a walk, so they leave the office and walk down a nearby path. Diane’s own mother passed several years ago, and Diane briefly shares her own experience at the moment of her mother’s death because she feels such self-disclosure will be helpful to Lisa. Lisa asks Diane additional questions about Diane’s experience which leads to a deeper discussion around Lisa’s own fears. Lisa asks Diane to attend her mother’s future memorial, to which Diane agrees. At the end of the session, they return to the office where Diane gives Lisa a hug. The next day, Diane sees Lisa in a local coffee shop. Lisa is sitting with some friends. Diane approaches Lisa’s table and warmly greets Lisa. Lisa introduces Diane as “a friend of a friend.” Has Diane crossed any professional boundaries? Has she violated any boundaries?
The above example underlines the complexities of maintaining proper boundaries as a mental health professional.
What is a professional boundary?
Professional boundaries define appropriate behavior between professionals and the public. Power imbalances often exist within a professional relationship, and boundaries serve to protect both the public and professional. The therapist/client relationship is built upon trust, safety, and respect. While building a therapeutic alliance is an essential component of therapy, a therapist must maintain appropriate standards of conduct with clients at all times, both in and out of the office.
What is a boundary violation vs a boundary crossing?
A boundary violation involves any behavior or interaction which causes harm to the professional or public. If the trust inherent to the therapist/client relationship is exploited or abused, through either sexual or non-sexual misconduct, a boundary violation has occurred.
A boundary crossing may be clinically useful depending on a therapist’s school of thought and treatment plan. A client’s therapeutic interests should be considered at all times. A cognitive behavioral therapist may find it clinically useful to drive with a client who is scared of driving. A humanistic therapist might serve tea to clients whereas a psychoanalytic therapist would not.
What are potential boundary violations between therapists and clients?
- Emotional violations: Mismanaging feelings of transference or countertransference with a client, failing to recognize that a therapist is not a peer, parent, or friend.
- Social Media violations: Communicating with clients on social media, posting inappropriate or sexually explicit content on one’s personal social media. It is prudent for therapists to include a Private Practice Social Media Policy in their treatment agreement signed by each client.
- Communication violations: Leaving a voicemail for a client without their prior written consent, greeting a client outside of the office without their prior consent and discussion.
- Physical violations: Inappropriate physical contact between therapist and client such as an unwanted hug, hugging only certain clients but not others.
- Relationship violations: Engaging in a romantic or sexual relationship with a current or former client, flirting with a client, going to a client’s home for non-clinical reasons, inviting a client to the therapist’s home, driving a client in the therapist’s vehicle, bartering arrangements not in the interest of the client, accepting significant gifts from clients, holding therapy outside the office without informing a client of potential confidentiality risks (and documenting their consent).
- Power violations: Using a client’s personal connections for personal gain, abusing a therapist’s position of authority to harm or exploit a client.
- Financial violations: Loaning money to a client, asking a client for money, not maintaining a consistent fee policy across clients.
While many of the above examples are clear boundary violations for a mental health therapist, others are not so clear cut and are the source of ongoing debates within the mental health field. Consider a therapist who lowers her fee for one client who has had a recent hardship but not for another client who has also had a hardship, a therapist who loans a client a book from a mutually-loved author, or a therapist who accepts a client’s Facebook friend request. Therapists must learn to recognize and stay educated on potential boundary breaches and should regularly consult with their supervisor and colleagues to minimize the risk of boundary violations.
How does a therapist maintain appropriate professional boundaries?
All behaviors and interactions between a therapist and client should prioritize the well-being of the client. Therapists have a unique position of authority and trust. Therapists must know the difference between the potential clinical benefits of boundary crossings versus the harm associated with boundary violations. Therapists must be vigilant in considering the implications or consequences of their behavior.
Examples of therapists at risk for boundary violations:
- New therapists: Potential boundary violations may be more difficult to recognize for those newer to the profession. Newer therapists should regularly consult with their supervisor and legal contact within their professional licensing board to minimize the risk of boundary violations.
- Similarly-aged therapists/clients: Therapists of similar age to clients can develop transference/countertransference more commonly.
- Therapists practicing in small towns or rural settings: Therapists who work in a small town or rural communities may see their clients frequently outside of sessions. Therapists should educate their clients on the implications of such potential boundary issues and develop a mutual plan as to how such encounters should be handled in order to minimize boundary violations.
- Therapists with dual relationships: Some therapists may hold dual relationships with clients. A therapist may have children in the same class as a client’s child. A therapist may work in a small town where the client works at the only supermarket in town. Dual relationships can be messy, and vigilance is required to avoid a slippery slope of boundary violations.
- Therapist’s at risk for their social/emotional health: Therapists who are undergoing difficult personal circumstances such as grief, loss, divorce, or parenting challenges be at greater risk for blurred boundaries.
Questions therapists should ask themselves:
- Do I treat any particular client differently than other clients?
- What is my social media policy related to my clients?
- Do I have any inappropriate content on my personal social media accounts?
- Would I behave differently with my client if I was in the presence of my supervisor?
- Do I dress or act differently when I know that I will see a particular client?
- Has a colleague ever questioned my behavior toward a client?
- Would I have concern about another therapist behaving as I do?
- Do I ever put my own well-being above that of my clients?
- Am I currently having any personal difficulties that could affect my professional judgement?
- Do I regularly consult with my supervisor or consultation group about potential boundary risks?
- Am I following the standards of conduct expected by my licensing board?
If you are a mental health professional facing disciplinary action, it is imperative to enlist the assistance of an experienced licensing attorney at the earliest stage of the disciplinary process. The Law Offices of Lucy S. McAllister are here to help. We understand the unique legal complexities facing those in the mental health field. We have the knowledge and experience to craft a comprehensive strategy and are dedicated to navigating your specific case through the disciplinary process to best defend your professional interests.
The Law Offices of Lucy S. McAllister have successfully represented a wide range of California licensed professionals including mental health practitioners, educators, nurses, and physicians. We are experienced in handling all types of licensing issues. Let us help you protect your professional license, your reputation, and your livelihood.
For additional information or to schedule a consultation on a professional licensing issue, please contact us today at (877) 280-9944.
For Additional Information
Setting Limits: Understanding Boundaries in Therapy
Patient-Therapist Boundary Issues