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What are professional boundaries? What is a boundary violation? Who is harmed by boundary violations? Why is professional boundaries training so important? Who should consider professional boundaries training? Who benefits and how? Why are professional boundaries important in our work? Does client consent make a sexual relationship acceptable? What are some potential consequences of a service provider having loose or poor professional boundaries? What are some factors that could make it hard to create and maintain professional boundaries? What is the boundary issue? How could this boundary issue affect the client? How could this boundary issue affect the worker? What could the worker have done differently to establish and maintain healthy boundaries with the client? What is Transference? What is Counter-Transference? |
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What are professional boundaries? Professional boundaries define effective and appropriate interaction between professionals and the public they serve. Boundaries exist to protect both the professional and the client. Clearly established limits that allow for safe connections between service providers and their clients “Being with” the client, not becoming the client Being friendly, not friends The ability to know where you end and the client begins A clear understanding of the limits and responsibilities of your role as a service provider Role modeling to the client healthy communication and professional relationships Avoiding the “rescuer” role Staying focused on one’s responsibilities to the client & the provision of helpful and appropriate services to the client Avoiding burn-out (“compassion fatigue”) If working in conjunction with other services providers: maintaining a healthy, open, communicating and functioning team Maintaining one’s physical and emotional safety Consequences of Having Loose/Poor Boundaries Compassion fatigue – the service provider’s role may not feel sustainable Potential for “splitting” on teams Client may not be given appropriate or helpful services, which could affect his/her willingness to accept future services Client may feel betrayed, abandoned, and/or poorly served Service provider may act unethically The reputation of the service provider’s agency and/or profession may be compromised Service provider and/or client may be emotionally traumatized and/or put in physical danger Signs that Boundary Issues May Be Present Between Service Provider and Client Client and service provider begin referring to each other as friends Service provider receives gifts from or gives gifts to client Client has or is asking for service provider’s home phone number or other significant personal information Client asks/expects service provider to socialize with him/her outside of professional setting (e.g., client asks service provider to begin attending church with his/her family) Service provider reveals excessive personal information to client Service provider is unable to sleep due to anxiety related to client/client’s situation Discussion regarding work/clients dominates service provider’s social interactions with friends & family Service provider offers to provide assistance to client outside of his/her role Service provider finds him/herself “venting” with client about other service providers on team What is a boundary violation? Any behavior or interaction which, damages the patient, the professional, and/or the therapy is a violation. It is the victimization and exploitation of a patient by the professional. It is a betrayal of the sacred covenant of trust. This includes sexual and non-sexual misconduct. Who is harmed by boundary violations? Boundary violations harm the patient and the professional. The ramifications are widespread. Damage usually extends to marriages, families, other patients, communities, clinics, institutions, and the profession in general. Why is professional boundaries training so important? The legal environment demands and the public expects strict adherence to professional boundaries. No conscientious professional sets out to violate standards of appropriate, professional relationships with clients or patients, yet violations continue to occur. It can happen to those that are dedicated, moral and highly professional in the overall conduct of their practice. Smart Boundaries™ training is essential for professional protection. Who should consider professional boundaries training? Anyone in a fiduciary relationship is at risk, especially those in the professions of medicine, psychotherapy, law, education and ministries. Who benefits and how? Implementation of Smart Boundaries™ fosters healthy and safe boundaries. This improves interpersonal skills, which in turn, reduces the risks for boundary transgressions. Patients, clients, professionals, clinics, hospitals, institutions and corporations are safeguarded. What continuing education courses do you offer? Identify poor boundaries. •You and your client call each other friends and interact outside of the facility where you work. •Valuable gifts are exchanged between you and the client. •You reveal personal information that is not relevant to your client's case. •You find yourself discussing the client and his or her case during social interactions with your family and friends. •You are having discussions with the client about other social workers or staff members at the facility. Know the consequences of poor boundaries. •Without professional relationship boundaries you may not provide appropriate services to your client. If you are acting as the client's friend, and not his or her provider, you may not challenge the client to deal with presenting problems or terminate services when it is appropriate. •Talking to your client about other staff members could lead to "splitting." Splitting occurs when a client says negative things to different members of a staff that eventually pits them against each other. •Failure to set professional boundaries can cause you to burn out from caring for your client beyond what is required of a professional relationship. You can have too much compassion for the client that will make it difficult for you to provide the objectivity your client needs. •If you do not maintain professional boundaries, you may find yourself acting in an unethical manner, such as becoming sexually involved with the client. •You and your client may be emotionally traumatized by the relationship. Create strong professional boundaries. •Explain your role as provider and the limits of your availability to the client outside of office hours at the beginning of the relationship. Make it clear that the client will only be able to contact you at the facility and that your personal life (outside of the relevant information you volunteer) is not up for discussion. •Make sure that any personal information you reveal (called self-disclosure) is helpful to the client's case. •When a client crosses the professional boundaries, redirect them by immediately clarifying your role and the limits of your relationship with the client. •Avoid having a dual relationship with a client. A dual relationship occurs when you have a therapeutic relationship with a client and you have some form of interaction with him or her outside of the facility. For example, you may be providing therapy to a client and then discover you both attend the same ______. Your options could be to assign the client to another _______ or to change the time you attend ______ services to avoid interacting with the client. •Discuss boundary issues with your supervisor, colleagues or your own __________. •Be sure to maintain good physical, emotional and mental health so you work at your personal best. Does client consent make a sexual relationship acceptable? If the client consents, and even if the client initiates the sexual conduct, a sexual relationship is still considered sexual misconduct for the health care professional. What is Transference? Transference is generally defined as the set of expectations, beliefs, and emotional responses that a client brings to the client/therapist relationship. Transference reflects not necessarily who an occupational therapist is, or how an occupational therapist acts in reality, but rather what persistent experiences a client has had with other important authority figures throughout life, such as a parent. Transference involves how those experiences influence the client’s relationship with his or her occupational therapist; for example, whether the client likes, idealizes, feels attracted to, or feels irritated or angry towards the occupational therapist. What is Counter-Transference? Just as clients bring transferential attitudes to the therapeutic relationship, occupational therapists themselves often have counter-transferential reactions to their clients. Counter-transference may take the form of negative feelings that are disruptive to the client/therapist relationship, but may also encompass disproportionately positive, idealizing or even eroticized reactions. Just as clients have expectations — such as competence, freedom from exploitation, objectivity, comfort and relief — occupational therapists often have unconscious or unspoken expectations of clients. |