The gray areas of boundary crossings and violations

Am J Psychother. 2003;57(4):429-44. doi: 10.1176/appi.psychotherapy.2003.57.4.429.

Abstract

The term "boundary violation" has become synonymous with unethical practice in psychotherapy, prompting a "black-or-white" view among clinicians and boards of review. But the current conceptual ambiguity about boundary interventions subjects clinicians to after-the-fact second-guessing that can be professionally ruinous at worst and may contribute to stultifying defensive therapeutic rigidity at best. It is crucial to demarcate the differences between boundary violations and boundary crossings (to be defined below) as clearly as possible, to describe the "gray areas" of each, and to recognize the heterogeneity of boundary violations and boundary crossings. These matters are of additional importance to those who teach, train, and supervise the next generation of clinicians. This paper will attempt to delineate a more clinically realistic and useful view of boundary crossings than has been proposed before, and illustrate the practical advantages of recognizing the spectrum of boundary interventions.

MeSH terms

  • Ethics, Professional*
  • Humans
  • Professional-Patient Relations
  • Psychotherapy / ethics*
  • Sexual Behavior