Establishing Boundaries
Although boundary setting is an important aspect of all therapeutic relationships, forensic alcohol and other drug (AOD) clients often have a history of violating personal and professional boundaries in serious ways. These populations are also likely to have had experiences of trauma and/or violations of their own personal boundaries in the past. As such, those working with forensic clients should be aware of, and emphasise the importance of firm boundaries, to ensure safety, ethical practice and good treatment outcomes.
Boundaries refer to the limits placed on behaviours and interactions between a clinician and their client, ensuring that the therapeutic relationships functions in the best interest of the client. Forensic clients are likely to display manipulative behaviours, so ensuring firm boundaries also serves as a protection to the clinician. Where crossing boundaries may at times be considered therapeutic in work with some AOD clients, the nature of forensic work means clinicians must take additional care to ensure appropriate clinician-client relationships.
Client boundary violations
Examples of boundary breaches:
- Lateness or missing appointments
- Criticising the clinician
- Asking personal questions
- Not paying attention, refusing to answer questions
- Complementing the clinician
- Giving the clinician gifts
- Aggressive or threatening behaviour
- Asking for special favours or special treatment
It is essential that the clinician is always consciously aware of what their role is within the therapeutic relationship and what actions may limit their ability to fulfil these responsibilities. Although maintaining firm boundaries is vital when working with forensic clients, some situations are not black and white, so you may need to use clinical judgement and seek supervision in times of uncertainty.
Given the client population, boundaries are likely to be challenged or crossed, and it is important that clinicians have strategies in place to manage these issues when they arise. When boundaries become blurred, clients may take advantage of the situation or begin to take control of the clinician’s role (e.g. setting appointment times, asking personal questions).
Exploring the underlying motives or reasons for a client’s boundary crossing can have important implications for treatment. For example, a client asking personal information may indicate confusion of the clinician role or alternatively may indicate deliberate attempts at manipulation.
Tips on managing boundaries:
- Discuss mutual expectations at the beginning of treatment
- Be honest and authentic in your relationships to build trust
- Maintain consistency with clients
- Avoid disclosing personal information
- Clearly define your role and its limits (e.g. “I’m sorry, but I don’t have the authority to…”)
- Seek supervision
- Follow correct organisational procedure
- Carefully document interactions with the client, especially any involving boundary beaches
- Don’t make promises that you can’t deliver and deliver on what you promise
- Advise of your response to breaches (e.g. lateness, attending substance affected etc)
- Act only within your defined role
- Maintain good social supports amongst colleagues
Professional boundary violations
Given the intensive nature of work in forensic settings, professional boundaries may be eroded over time, particularly as therapeutic relationships develop. Identifying and addressing your own professional behaviours that might indicate boundary violations, is an important aspect of ethical practice and effective treatment.
Clinician boundary violations:
- Excessive joking with the client
- Stereotyping clients who engage in certain behaviours
- A belief that only you understand the needs of the client
- Changing your behaviour during interactions with the client
- Doing favours or spending extra time with the client
- Losing hope
- Agreeing with anti-social attitudes (e.g. towards police)
- Avoiding challenging of negative behaviours
- Avoiding discussing client difficulties with peers/supervisors
Managing professional boundary crossings:
- Monitor your level of involvement with clients (e.g. over or under-involvement may indicate a blurring of boundaries)
- Ensure that the therapeutic relationship is not misread or confused with a personal relationship
- Recognise that your own behaviours provide information about the client’s presentation, and seek supervision accordingly
- Engage in self-care practices regularly to avoid burnout/compassion fatigue
- Reflect on your own practice (e.g. be aware of your own vulnerabilities and negative responses and what might be driving them)
- Always stay in role
- If you believe a boundary has been crossed, consult your supervisor for guidance
Self-disclosure
It is vital to protect your personal privacy and avoid disclosing personal information when working with forensic clients. While asking personal questions may seem benign, clients may have antisocial personality disorder and/or psychopathy and can use personal information to manipulate you.
Never disclose specific details such as your home address, phone number or details of your family members. If asked questions of this nature, seek to explore the reason for the question (i.e. lack of trust, lack of respect for privacy, manipulation) and find your own way of answering these questions that align with your therapeutic style.
Disclosing too much information can reinforce avoidance behaviours, give clients inconsistent signals of the clinician’s role, and take up time in therapy that should be devoted to the client. Additionally, over-disclosure of personal information can be a warning sign of burnout and compassion fatigue – suggesting a need for more careful consideration of your own professional boundaries.
Responsibilities of managers/supervisors:
- Model appropriate professional boundaries with clients to your supervisees
- Be open to discussing supervisee concerns
- Develop a workplace culture that allows open discussion of concerns/risk amongst team members
- Actively and regularly engage in clinical supervision
- Have an awareness of the factors that may contribute to breaches of professional-client boundaries and communicate this to your supervisees
