As a practicing psychologist I have argued for many years that boundary crossings can often be extremely helpful, whereas boundary violations are usually harmful, and that many therapists confuse the two. Therapy is often shortchanged by the tendency to practice defensively, to allow the fear of attorneys and licensing boards dictate how we treat our clients. It is imperative not to exploit, disparage, abuse or harass a client, and to steer clear of any sexual contact. We must also appreciate the significance of confidentiality, integrity, respect, and informed consent. In my opinion all the rest of the ethical rules, codes, and regulations are negotiable.
It is the mandate of the state licensing boards and professional ethics committees to oversee that no client is harassed, exploited, or harmed. There is almost universal agreement, for example, that a therapist should not enter into a client-therapist sexual relationship of any kind. Clinicians who do not follow these rules can face severe consequences, including state investigation, public humiliation, loss of their licenses and livelihoods, civil liability and even criminal indictments. Many of these regulations are necessary and sensible, especially those that enforce strict consequences for sexual or other forms of exploitation, but over the years, the rulebook has become needlessly stringent and rigid, and so inflated that, at times, it undermines effective therapy.
It seems to me that some members of regulatory boards and ethics committees are imbued with a risk adverse mentality and administrative zeal. They are apt to impose extreme penalties for minor infractions. Even worse, they have labeled various benevolent acts "unethical" and have chastised clinicians for engaging in them (e.g., driving a client to a railroad station during a taxi cab strike, accompanying an anxious client to a dental visit, or helping a client acquire a better sense of self by socializing with him or her). One is warned to eschew "dual relationships" and never to step outside the bounds of a sanctioned healer.
In my opinion, too many members of our profession compromise and undermine their true healing potential by forfeiting the benefits that selected clients can gain from a boundary crossing. Here is a case in point:
Cindy, aged 31, consulted me for help with what appeared to be an agitated depression. She had seen a therapist for almost three years who had successfully assisted her in resolving numerous family issues, relationship problems, panic attacks, and work-related difficulties. The therapy ended by mutual agreement a few months after Cindy met a man, became engaged to him, and the two of them saw her therapist for a few successful sessions of premarital counseling. "We invited Dr. M. to the wedding but she declined the invitation on the grounds that she considered it inadvisable to socialize with clients or former clients." Cindy said that she felt humiliated, demeaned, and invalidated by this rejection and added that she now questioned whether her therapist ever really cared about her. Suffice it to say that it took several months of therapy before I was able to help Cindy overcome this needless and unfortunate setback.
I do not consider out-of-office activities designed to establish rapport a "boundary violation," and nor do I regard going to a client's wedding as a "dual relationship." However, too many therapists do look upon them as ethical violations, and they strongly oppose any interaction beyond the confines of the office. Such thinkers may, at the very least, shortchange their clients.
Remember: Think well, act well, feel well, be well!
