Chapter 12:​ Addressing Self-Disclosure and Other Boundary Issues

post midterm

Professional Boundaries​

• Work centered on the client’s needs, not the clinician’s​

• Time constraints and number and length of meetings provide structure​

• Not a friendship​

• Sexual contact forbidden

Disclosure of Clinician Personal Information​

• Self-disclosure​

  -Can be used as part of other skills​

  -Information sharing​

  -Modeling​

  -Empathy building​

  -Examining the moment​

• Should be client-centered sharing, not clinician-centered or irrelevant​

Disclosure of Clinician Personal Information

Things to consider before self-disclosure​:

• Consider intended purpose and consequences before​

• Why at this moment?​

• Is it in the client’s best interest?​

• What are potential effects on client?​

• Is it for clinician’s or client’s needs?​

• How will I feel if client tells others?​

Disclosure of Clinician Personal Information

Things to consider after self-disclosure:​

• How does client understand what shared?​

• Did client have reactions?​

• Did self-disclosure have intended effect?​

• Ask client how it affected him or her​

• Would I do it again?​

Disclosure of Clinician Personal Information

Disclosure by others​:

• Client discovers information accidentally​

• Client seeks information from others intentionally​

• Evaluate the effect of what client has learned and directly address with client

Disclosure of Clinician Personal Information​

Responding to personal questions​:

• Think carefully about effects of both answering and not answering​

• Give direct answers or explain why not answering​

• Ask client purpose of the question​

• Explore client’s fantasy about the answer​

• Can reduce unequal power in relationship​

Disclosure and the Internet​

• Clients may discover information about the clinician from:​

  -Clinician postings on social media​

  -Clinician images online​

  -Rating sites, such as healthgrades.com or Yelp​

• Be careful about presence on Internet​

Confidentiality Issues​

• Directly address at beginning of the relationship​

  -Both confidentiality and its limitations​

• Always address as a boundary issue and its impact on the relationship as it arises​

Limits on Clinical Conversations​

• Boundaries within the conversation​

• Focused conversation​

  -Focus on task​

  -Structure concentrates and clarifies the conversation​

Limits on Clinical Conversations​

Proscribed conversation​

• Agency prohibitions against discussing certain topics​

• Inform clients of limits and their sources​

• Refer to others as necessary​

Out-of-Office Contact​

Planned contact​:

• Any meeting outside of normal setting​

• Attending special events​

• Discuss with supervisor first​

• Reinforce roles and boundaries as indicated​

• Directly address implications​

  Unplanned contact:​

• Not part of the work​

• Prepare for possibility ​

• Put client’s needs first and avoid situations where clients may be uncomfortable with clinician presence​

• Careful about confidentiality

Requests for More Time

Response influenced by:​

• Clinician’s practice framework​

• Agency’s rules and procedures​

• Clinician’s assessment of client’s needs​

• Available time and energy​

  -Always address meaning of request​

  -Clarify limits and alternative sources of help​

Legally Mandated ​Boundary Intrusions​

• Court ordered​

  -For example, child protective services entering a home and taking away a child who is in danger​

• Usually only occur after outreach or in situation of imminent harm​

• Reveal imbalance of power in client-clinician relationships

Gift Giving and Receiving

Client gifts to clinicians:​

• Can be symbolic messages about the relationship​

• Symbol of thanks or welcome in many cultures​

• Clinicians may discuss rather than accept​

• Be aware of own reactions to receiving gifts​

• Supervisors can help frame responses to gifts​

Gift Giving and Receiving

Clinician gifts to client​:

• Symbol of the bond or the work​

• Transitional object at times of separation in the clinical relationship​

• Be sure gift is appropriate​

Use of Touch

• Influenced by cultural beliefs and preferences, as well as clinical theoretical orientation​

• Clients have been exploited by clinicians’ inappropriate touch​

• Attend to unintentional impact on the relationship

Limit setting

The technique of restricting, with respect and caring, a client’s inappropriate or destructive comments, behaviors, or requests in order to maintain clear and comfortable boundaries.

Limit Setting

• Essential to good clinical work​

• Important for client growth​

• Can be internalized as helpful structure​

• Helps client learn self-containment- an important skill in relationships​

Self-Reflection on Boundary Issues

• All clinicians will experience boundary issues​

• Never too soon or too late to reflect on​

• Always question your actions and think about possible effects​