Psychotherapy is successful when boundaries between the therapist and the client are well-defined. As in any relationship between two people, it is an ongoing process of defining borderlines between the two personalities. However, in psychotherapy, there are some ethical concerns, norms, and guidelines which are very important to follow.
Boundaries are a crucial element in the therapist-client relationship and they constitute a large part of any therapeutic change—they can provide a predictable frame where both participants in psychotherapy can (more or less) anticipate what to expect from each other. They refer to the “psychological, emotional physical space between the therapist and the client.”
For example, boundaries in therapy might refer to physical touch, self-disclosure, giving gifts, activities outside the office, etc. In each case, there is a danger that the therapist is stepping outside of his professional role and crossing this expected boundary between the client and himself/herself. But not all boundary crossing is necessarily harmful. Giving a nonsexual hug to a client after a long and difficult session might be a sign of respect, warmth, support, and unconditional positive regard by the therapist. In fact, some argue that nonsexual boundary crossings can enrich psychotherapy—but they can also disrupt the therapist-client alliance too. Also, attending a stand-up comedy appearance in a local pub can be a good way to support a client who is struggling with social anxiety. And lending a self-help book to a client could be a part of psychotherapy treatment (bibliotherapy).
Different schools of psychotherapy differ in their views on crossing boundaries. Different therapists also have their own attitudes toward this issue. But this does not mean that there are no strict rules of what the therapist can and cannot do. Clear examples include inappropriate behaviors, such as having sex with clients. Further, the therapist cannot be engaged in any kind of dual relationship outside the therapeutic relationship, e. g. the therapist and the client cannot be friends. Dual relationships can be especially harmful since they introduce confusion and subsequent harm to the therapy process. Most serious violations of boundaries by the therapist include abuse of power or making gain from the client outside the therapy (for example, engaging in a business enterprise with the client).
However, this does not mean that all kinds of dual relationships have to be harmful. Most ethical guidelines do not mandate an extensive avoidance of dual relationships. Sometimes dual relationships cannot be avoided, as in small rural communities, military or college settings, etc. Nevertheless, most professional associations’ codes state that multiple relationships should be avoided if they have the potential to seriously harm the client and are detrimental to the therapy process. Sometimes this is entirely obvious and an ethical psychotherapist will never abuse his or her power in the relationship. Sometimes boundaries are flexible and they have to be malleable to some extent. Therapists are professionals who have, like other people, private lives and families. Their paths can cross with clients in unexpected places and in surprising ways. It is impossible to live in complete isolation and not interact with other humans just because one is a therapist. Obviously, therapists can have similar interests with their clients, i. e. frequent the same places, concerts or theatre plays. But this is not considered to be a dual relationship since it is happening by chance and it is not enough to constitute a relationship outside the therapist’s office.
Good therapists can recognize when their behavior is gravitating towards crossing the borders—and they will usually do something about it. In some cases, hugs will come naturally at the end of the session; in some cases, hugs will feel weird or awkward. Extensive self-disclosure of the therapist can also be viewed as boundary crossing since it represents an abuse of power and shifts the focus from the client to the therapist. But describing some situation from the personal life of the therapist might be necessary (or the therapist might feel there is significant value in discussing this story), because the situation is highly relevant for the client, and sharing personal experience has the potential to influence therapy outcomes and additionally strengthen the therapeutic alliance. At the end of the day, the most important thing to keep in mind for the therapist is that therapy is not about him or her—it should be about the client. If we as therapists are aware and mindful of this, everything else will fall into place.
Vladimir Mušicki, PhD 