Clients who Cross the Line
Clients who cross professional boundaries present significant challenges, including how to manage the situation without putting yourself at risk for legal action related to inappropriate behavior. Before describing strategies for dealing with boundary crossing by a client, here’s a quick look at boundary crossing and how to prevent it.
What is boundary crossing?
What constitutes boundary crossing varies, but it generally applies to anything that impinges on the therapeutic relationship between client and counselor. Such actions might include large gifts, sexual advances, repeated missed appointments, or social contact outside of appointments. Psychotherapist John Bradshaw breaks down boundary crossing into five categories: sexual, physical, emotional, intellectual, and spiritual.
Be aware of ethical codes and practice guidelines related to boundaries from associations such as the American Psychological Association (APA) and the American Counseling Association (ACA). Typically, they prohibit “dual relationships,” where the counselor fulfills multiple roles. The counselor may also be the client’s friend or an investor in his or her business. Other areas often covered in codes of ethics include guidelines for accepting gifts.
In addition, be familiar with your state’s regulations and legislation addressing the client-counselor relationship, your employer’s policies (if applicable), and articles related to professional boundaries.
Establish boundaries from the start of the counseling relationship. Talk to your client about items such as the purpose of the relationship, fees, and appointments, and document your discussion. Have the client sign a form that he or she has received the information. In essence, you’re obtaining informed consent.
Sit at an appropriate distance during the appointment and be cautious when touching a client because it can easily be misinterpreted. Don’t disclose too much personal information. It’s acceptable to receive small gifts of gratitude, but nothing that’s valuable or creates some kind of indebtedness to the client. You should document all gifts received.
If you’re unsure whether a boundary has been crossed, consult your association’s code of ethics and standards.
The goal isn’t to appear rigid and unfeeling, but to establish the “rules” of the relationship. Perhaps one of the most important ways to deal with boundary crossing is to act promptly.
How you handle a client who crosses professional boundaries depends on the behavior. However, some general guidelines can help.
Don’t let issues build. If the client makes an inappropriate comment, say so right away. Document your conversations objectively. For example, state the client’s exact words rather than, “Client made sexual innuendo.”
If you’re unsure whether a boundary has been crossed, consult your association’s code of ethics and standards. You can also talk with trusted colleagues and document the consultation to show that you sought advice. The ACA offers its members free, confidential ethical and professional standard consultations.
Have a plan
Devise a plan for dealing with the boundary crossing. For example, a client may be repeatedly 20 minutes late for appointments. Establish that the next time the behavior occurs, the appointment will have to be rescheduled. Consider using an ethical decision-making tool to guide your actions for more complicated cases.
If you need to have a difficult conversation with a client, such as when he or she is making sexual advances, consider having a trusted colleague be part of the meeting.
In some cases you may need to refer the client to another counselor. If the boundary crossing was serious, for example, the client struck you, your emotional response can be strong and affect the rest of your practice. In this case, consider short-term therapy to address your own needs.
You can meet the challenge of clients who inappropriately cross boundaries by taking preventative steps, acting quickly, devising a plan, and referring clients elsewhere when necessary.
Cynthia Saver, MS, RN, President, CLS Development,Columbia, Maryland.