By: Mollie Charter, MSW
Book Review of
Preventing Boundary Violations in Clinical Practice
Preventing Boundary Violations in Clinical Practice, by Thomas G. Gutheil & Archie Brodsky, The Guilford Press, New York, 2008, 340 pages, $38.00.
What if one of your clients mentions that a branch of her company is closing, and you happen to have most of your savings invested in the company’s stock? Is it unethical for you to sell your stock based on information given to you in a session? What if a client brings a gift of substantial value during his last session? What will it mean to you and to your client if you don’t accept the gift, or if you do? What if a client hugs you at the end of a session? Are you then obligated to continue hugging the client at the end of every session?
Preventing Boundary Violations in Clinical Practice is an excellent resource that examines boundary concerns, like the ones above, exactly as they are: complex issues requiring substantial thought that are oftentimes anything but clear cut. Usually, we think of sexual misconduct when considering boundary violations, but every element of the therapeutic relationship may pose boundary issues. Gutheil and Brodsky contend that even the most well-intentioned clinicians may find themselves struggling with a boundary concern. The authors have conceptualized this book as a “supervisor on a bookshelf,” and as with a good supervisor, the reader can come looking to gain a broad understanding of boundaries or with specific questions and concerns.
The authors divide the book into three sections: Foundations, Explorations, and Implications. In addition to detailing some of the essential principles of the therapeutic relationship, in Foundations, the authors differentiate between “boundary crossings” which are unusual occurrences in therapy, and “boundary violations” where the intention of the therapist is not in the best interest of the client and/or harm is caused to the client. Crossings, they note, can lead to violations, but crossings that are acknowledged and examined may actually serve to prevent violations. In Explorations, the authors take an in-depth look at the many areas of the therapeutic relationship that can pose potential for boundary violations. This section covers a wealth of possible issues, ranging from how a client dresses and problems with payment, to sexual misconduct. The final section, Implications, examines the impact of boundary violations on clients and therapists, and outlines who is most at risk for violations. Also explored are common misunderstandings related to boundary issues and recommendations for prevention.
The genuine compassion extended to clinicians who face boundary issues and the echoed sentiment that there is hope and help are among the most successful elements of this book. The authors demonstrate that clinicians from a variety of backgrounds may find themselves facing complicated boundary issues and present a number of ways to work through the issues before they become violations. Also very poignant are the vignettes, which illustrate interesting cases and suggest helpful dialogue that can be used with clients when discussing boundary concerns. The authors are careful to note the importance of context when discussing boundaries, and although this book is geared toward a clinical relationship, it could be helpful to social workers in a variety of settings.
Preventing Boundary Violations in Clinical Practice is a great foundational read for both newer and seasoned clinicians. It is also a book to keep in your office to leaf through when you face a potential boundary crossing, such as noticing you wanted your client to stay longer than the allotted time, or when you are staring at a gift that is sitting unopened on your desk. Even when you just have an uncomfortable “something feels weird here” feeling, Preventing Boundary Violations in Clinical Practice is a resource you can turn to for helpful suggestions and reassurance.
Reviewed by Mollie Charter, MSW, graduate of Boston University in the spring of 2008. She currently lives in Denmark, which has afforded her the opportunity to travel much of Europe. She is keeping up with social work through volunteering for an organization for people with mental illness and for a multicultural women’s organization, in addition to writing.