Establishing & Maintaining Boundaries Boundary Crossings & Boundary violations Boundaries and Boundlessness

 Effective therapeutic relationships are founded on trust  The client enters therapy vulnerable and anxious  Safety is created by the therapist through the consistent offering of the core therapeutic conditions  Clear and consistent boundaries are a vital ingredient in creating a sense of safety and trust The importance of trust

Boundary: Defines appropriate professional behaviour & conduct. Boundaries are informed by professional role, practice, contract and context. What kind of boundaries are there? How and when do you establish boundaries? some definitions

Boundary Crossings: Harmless or beneficial departure from ‘normal’ clinical practice, either spontaneous or as a planned part of the therapeutic process For example: taxis fare in bad weather, use of touch in play therapy Helping client search for additional support What else? some definitions

Dual Relationships: Refer to situations when two or more connections exist between a therapist and a client. For example: when a client is friend, student, supervisee, business associate or employee of the therapist Boundary Violations: Are always harmful. They occur when a therapist misuses his/her power to exploit a client to satisfy the therapist’s needs : erotic, intimacy, financial, dependency, status or authority some definitions

 What would you do?

An approach  Identify the issue - for the client, for the therapist, for the agency  Possible Action What might you be required to do? What might you be prohibited from doing?  Making a decision What will achieve the greatest good - Beneficence What will achieve the least harm – Non-maleficence What will be the fairest – Justice What maximises the greatest choice for all involved – Autonomy  Impact and perception of decision for the client, for the counsellor, for the relationship, for the organisation, for colleagues, supervisor, professional body, for the general public

You have been working with a client for 6 sessions. The agency policy is to provide 6-10 sessions. The work is going well with your client, but you know that your client would like to engage more deeply with certain issues. Your client knows that he/she can only have 4 more sessions and asks if it is possible to extend the timing of the last 4 sessions form 50 mins to 1 hours 30 mins. You see this client at the end of the day, so it would be possible Can you see me for longer?

Can I call you? You are working with a young client 18 years old female. She has self referred into the service seeking help to ‘feel better’. She is homeless and living in a B & B. She has a history of drugs, self harm and suicide attempts. She has few friends. You like her and feel sad for her. During your last session she admits to feeling increasingly bleak and desperate. You know you are the only one she has shared this with. She says she doesn't’ think she can make it through the week without talking to you and asks you if she can call you between sessions.

Are you married? You are working with a client who is going through relationship difficulties. He/she is really struggling in the relationship and wondering if they should leave. The client is really upset and wants reassurance you understand their situation and asks you a number of searching personal questions about your home life and your relationships.

Can I have a hug? You have been working with a client for a number of months. He/she is depressed and lonely. During the last session they say that they haven’t had any physical contact with anyone for a year. At the end of the session, just as they are going out of the door. The client, with tears in their eyes, asks for a hug.

Will you work with me? You are approached by Sam, the teenage daughter of Penny (an acquaintance) who asks if you will work with her. You are not a close friend of Penny and hardly know Sam. Sam is insistent that you are the right person to work with her. It has taken her months to pluck up the courage to ask you and she says that she has already checked it with her Mum who says it is OK by her. You check with Penny yourself and she does not see it as a problem, she knows your work and is keen that you work with her daughter. You don’t want to let Penny down, she is a good colleague and influential in the organisation that you work in.

Can you see me at home? You are working with a client who has a terminal illness. The service you work in is open ended and you have been seeing this client weekly for several months. The client has a sudden relapse and is taken into hospital. The client’s partner contacts the agency to ask if you could see the client in hospital. The agency is not opposed to this, but says the choice is yours.

 Contracting issues: Confidentiality, fees, timing, cancellations, contact between sessions  Dual relationships: - professional or social  Nature of relationship – maintaining appropriate levels of intimacy – physical, and emotional and self disclosure  Information, advice, advocacy  Fees and gifts  Friendship potential crossings or violations

 Life crisis  Relationship breakdown  Major transitions  Illness  Loneliness  Financial difficulties  Small Town dynamics  Professional Issues: Over Identification with clients issues Creating ‘special relationship’ with client Vulnerability factors for therapist