Professional Boundaries in Therapy: Your Top 5 Questions

Professional boundaries are an essential part of therapy practice, helping you define where the therapeutic relationship starts and ends.

When you train as a therapist, you generally do so because you want to help people. Maybe you’re the sort of person everyone confides in anyway, and you decide to make a career of it. However, that desire to help can sometimes lead to over-facing yourself to the point of exhaustion and burnout. This is why clear professional boundaries matter so much. They are there to protect both you and your clients.

Here are some of the most common questions therapists ask about professional boundaries in therapy practice.

Q1. What Professional Boundaries Should Therapists Set?

This will depend on the shape of your practice and the type of therapy you offer. Broadly, though, you should be setting some rules or guidelines around:

• Confidentiality: what steps do you take to keep client information confidential and when would you break confidentiality?
• Fees: how much you charge, when, and how, this should be paid, what happens if payments are missed?
• Time: how long sessions last and how often they are held, how often you expect clients to attend, what happens if they are late, a cancellation policy.
• Contact between sessions: is this acceptable? If so, how often and under what circumstances should clients contact you? By what method? Is it acceptable to turn up at your place of work without an appointment? (Especially important if you work from home.)
• Gifts: do you accept thank you cards or gifts? If a bunch of flowers is OK, what about a gold watch? Where do you draw the line?
• Non-therapeutic contact (platonic or otherwise): do you draw a clear line between clients and friends? Do you connect with clients on social media, and if so, how? What if a client invited you to go out for coffee, would you go? If you would, where do you draw the line? Would you go on a date? Or a holiday?
• Individual boundaries: some clients may have boundaries of their own, for example, autistic clients may prefer you to communicate in specific ways, or to avoid certain words or approaches*. One gentleman on the spectrum associated people using his full name (rather than a nickname) with ‘being in trouble’ and didn’t like being praised. So saying ‘Well done, Jonathan, you have done a really good job this week,’ would impact negatively on your rapport.
  Other clients may not have told their families they are seeing you. In this case, you might check if their partner ever answers their phone or checks their emails. It might be important if you become unwell and have to contact them to rearrange an appointment.

Depending on your theoretical inclinations, you might also want to consider issues like self-disclosure and physical touch. Most of us are happy to disclose what training or professional experience we have, for example. But sometimes clients ask more personal questions.

If you’re supporting those with alcohol or drug addictions, it’s common practice to tell clients if you’ve had these issues yourself in the past. It’s perhaps less relevant to give the same information to someone who wants to deal with a fear of spiders! Regarding touch, some therapeutic approaches encourage hugging, others would see it as crossing a line.

Q2. How Can Therapists Make Professional Boundaries Clear to Clients?

Go through them at every initial session and put the most important ones in a written contract or T&C. Provide this to every client and ask them to sign it.

It’s especially important to do this if there are circumstance under which you might want to break confidentiality. In UK law, there is no universal requirement for therapists to break confidentiality to protect a client or others. Your Code of Ethics, which might require it, is not legally binding. Your contract with the client is, so having it in there makes sure everyone knows where they stand.

If a client is crossing a boundary, for example, phoning you at all hours to report their progress, talk to them about it in their sessions. Try to agree a way forward that suits both of you. If they can’t stick to boundaries, consider referring them on.

Q3. Why Are Professional Boundaries Important in Therapy?

You know that you are professional, reliable and ethical but it’s not enough to be those things. You have to demonstrate that you are those things. Boundaries are what help you show the client you are serious about them, your professional relationship, and the help you offer.

Reasonable boundaries are not restrictive, but offer clients a safe framework in which to explore their issues. It can also make it easier to talk to them about any problems that might arise: constant lateness, frequently rearranging appointments at short notice, failure to pay, etc.

Q4. Should Therapists Ever Relax Professional Boundaries?

This is tricky to answer. Someone, somewhere will always be able to think of a situation where it would be appropriate to ignore an established boundary. For example, you may discourage contact by phone between appointments. But if a client rings to say they are at immediate risk of suicide, you’d be unlikely to respond by reminding them you prefer emails between sessions.

Or say a client fails to turn up. Later, you find she was run over on the way to your session. In this case, you would probably waive your “less than 24 hours notice” fee. (This really happened to one of my clients! She was taken to hospital for checks, but was OK.)

And so on.

Outside exceptional circumstances, though, your boundaries should be clear and firm. This is not unsupportive or uncaring, it is acting within the parameters of a professional relationship. Extending a session because client A is late (however good their reasons) means that client B’s appointment doesn’t start on time. Or that you are late home to your family (who also deserve your time and attention). Or that your self-care routine is put aside to make the extra time.

You want to be generous with your attention and expertise, of course. But no other professional gets paid for an hour, and throws in a free 24/7 support system.

Q5. How Can Therapists Maintain Professional Boundaries?

• As said, put them clearly in your contract.
• Don’t provide work that isn’t being paid for.
• Avoid dual relationships.
• Have a separate phone for work and switch it off outside of working hours.
• Reflective practice and supervision help you review how you respond to clients and how comfortable you are in dealing with requests that might cross boundaries.
• If a client genuinely needs more support than you usually offer, consider having a fee for that service. This might be something like between session texts or phone calls, or extra-long sessions.
• Learn to say no politely but firmly, and mean it.

As therapists, we want to do the best we can for our clients, of course. But caring for ourselves and running an effective business are just as much a part of our practice as client work. Balancing the three takes a bit of practice, but it can be done and you and your clients will feel the benefit.

Disclaimer
The information and ideas shared on this blog are based on the author’s professional experience, research, and training. They are intended for educational purposes and to support reflection and professional development. Therapists should always apply their own professional judgment and consider the needs of individual clients when using any techniques or suggestions discussed here.
While every effort is made to ensure the information is accurate and helpful, no responsibility can be accepted for any loss, damage, or difficulties arising from the use or misuse of material contained in these articles.