As a mental health care provider, you understand that boundaries are parameters an individual sets for how they prefer others to interact with them. While you may routinely help clients set boundaries at work or with their family, remember that setting boundaries and expectations (especially in the beginning of your work) with the client yourself is usually important for professional ethics as well.
Psychological literature emphasizes that boundaries can serve as a way to clearly define the roles of participants in the therapeutic process. When applied effectively, therapeutic boundaries can foster a sense of safety for clients, ensuring that practitioners act in the best interests of those they treat. Well-established boundaries can also help therapists feel more comfortable and lower the risks of certain challenges associated with this type of work, such as burnout.
There are various angles to consider when setting boundaries with your clients. The following are a few important tips that could help you in this process.
It can be beneficial to establish rules around your counseling relationship and services early on with clients. Some guidelines will involve filling out forms, such as those related to informed consent regarding the type of treatment the client is to receive.
Outside of those rules set by law or governing bodies, the rules you create will be entirely up to you (or the organization you are affiliated with). Some potential areas to cover may include:
Another vital type of boundary to set is around your relationship with your clients. In general, it should remain professional and consensual at all times. For example, one area to handle very carefully is the topic of physical touch. While some may appreciate occasional gestures like a hug or a touch on the shoulder from their therapist during particularly challenging sessions, you should communicate clearly and not assume that any type of physical touch will be welcomed by your client. Gaining explicit informed consent before any type of physical interaction (and consenting to it yourself as well) is a must to avoid potential boundary violations.
Note also that some types of contact are never appropriate between therapists and clients, even with informed consent. The most prominent example of this is touch, which is associated with a romantic or sexual relationship. The American Psychological Association (APA) and American Counseling Association’s ethics code prohibits providers from engaging in romantic or sexual intimacy with current clients or patients or their client’s close relatives, guardians, or significant others. Violating these guidelines can result in the loss of inclusion in the APA organization and sanctions on the offending party.
These relationships—which could be anything from a romantic connection to a business partnership—can impair a therapist’s ability to be objective and can make it difficult for them to effectively provide care. Multiple relationships also carry a risk of exploitation or harm for clients.
In relation to the mental health field, self-disclosure is when a provider gives out personal details about themselves to their patients or clients. Of course, a certain amount of self-disclosure may be unavoidable and could even promote trust in a therapeutic relationship. However, sharing too many details could be harmful. It may damage the professional relationship between you and your client, distract the client from their own challenges, and reduce the efficacy of therapeutic sessions. It could also lead a client to ask further questions, which might make you uncomfortable.
To reap the benefits and avoid the risks, it may be helpful to keep self-d*sclosure instances brief and relevant to the subject at hand. If you believe that certain, limited information may help your client and you are comfortable sharing it, you may decide to do so. Just make sure to have clear boundaries set on this topic ahead of time and be ready to respectfully say so when you don’t feel comfortable discussing a particular subject.
Even with the right boundaries in place, working as a therapist can come with a variety of challenges that may be difficult to manage alone. Demand for mental health care is increasing, and the APA reports that burnout among mental health professionals is high. Left unchecked, the stress associated with overwork may make it difficult to provide effective care and could also negatively affect your own health and well-being. Meeting with a therapist yourself is one way to address the challenges you may be facing, as they can help you find effective ways to establish boundaries at work and support you in developing healthy coping skills for stress.
However, if you’re feeling overwhelmed and stressed with your job, finding time to commute to and from in-person therapy appointments for yourself might seem impossible. That’s where an online therapy platform like BetterHelp can be an especially helpful option. You can get matched with a licensed provider who you can meet with via phone, video call, and/or in-app messaging from anywhere you have an internet connection. Research suggests that there’s generally no difference in efficacy between in-person and online therapy sessions in most situations, so you can typically choose the format that works best for you.
Setting clear boundaries and rules is an important part of building a strong therapeutic relationship. Consider the following practical tips that can help whether you’re beginning to establish boundaries or working to maintain healthy therapist-client boundaries.
Establish boundaries through written agreements
Counseling professionals may use written agreements, such as informed consent forms, to establish boundaries and expectations before beginning treatment. The informed consent process can help therapy clients understand where both parties’ responsibility lies and learn what to expect during each session.
Establish guidelines around communication
Many clients may wish to get in touch with their therapists or counselors outside of sessions, so it can be beneficial to set limits and rules regarding communication. For example, a therapist may establish acceptable times for phone calls or text messages and when clients can expect a response.
Protect client information
Protecting client information in a therapeutic setting can entail keeping records secure, clearly explaining the informed consent process, and obtaining informed consent before sharing information with others, such as other professionals or the client’s family members.
Ethics and boundaries are an important part of any ethical practice. Having a clear set of rules, limits, and ethical obligations can help protect both therapy clients and providers from harm and emotional distress. When a client feels safe in the therapy room, it allows them to open up about how they are feeling and form a stronger therapeutic relationship with their therapist. Boundaries can also serve as guidelines for appropriate behavior both during and outside of sessions.
It may be common for individuals with borderline personality disorder to have boundary issues as they may perceive rules and boundaries as a form of rejection, causing anxiety and emotional distress. When treating someone who has difficulty adhering to boundaries, it can be a therapist’s responsibility to communicate boundaries firmly and clearly while remaining empathetic to how the client feels. It can also be helpful to be consistent in enforcing consequences when clients break the rules or cross boundaries at any point.
Examples of boundary violations in therapy include dual relationships and self-disclosure. Dual relationships occur when a therapist pursues a personal relationship with a client in addition to their professional role. This can cause the therapist’s personal feelings or behavior to affect the quality of care the client receives, which, in turn, can affect client growth. Pursuing a romantic or sexual relationship with a client goes against the American Counseling Association’s Code of Ethics.
The decision to engage in physical touch, self-disclosure, see clients outside of normal hours, or accept gifts can lead to the development of personal relationships that go beyond what’s acceptable and violate ethics, especially if you don’t set limits regarding these behaviors.
Self-disclosure occurs when a therapist shares personal information about themselves with their clients. While a little bit of sharing may help build rapport, inappropriate self-disclosing may leave the client feeling burdened and impede treatment.
Healthy therapist-client boundaries may include rules concerning physical touch, communication, interactions outside sessions, and gift-giving. For example, a therapist may refuse to accept gifts, whether a client feels gift-giving is appropriate or not, to prevent conflicts of interest or potential boundary violations.
Setting boundaries means establishing a set of limits and rules that define the scope of treatment and the parameters of the therapeutic relationship.
A therapist can maintain boundaries with their clients by staying professional during each session and practicing effective communication. It can also be important for counselors or therapists to prioritize self-care and spend time with family or friends to reduce stress, allowing them to provide effective treatment to their clients in a way that’s realistic and practical for them.