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Maintaining Healthy Boundaries

in the Helping Relationship

Professional Mental Health Ethics

A Training Resource

By James J Messina, Ph.D., CCMHC, NCC, DCMHS-T

MAINTAINING HEALTHY ETHICAL BOUNDARDIES

CEU's: 3 hours based on request (CE Broker Tracking #: 20-615486)


Resource for Course on Coping.us: http://www.coping.us/professionalmentalhealthethics/boundarymaintenance.html


Description of Program: Boundaries must be set and maintained in the helping relationship to ensure that the Helper: 1. Does “no harm” to the helpee; 2. The rights of helpees are respected and honored; 3. The helper is always respectful of and conscious of the need to guard the privacy of the helpee; and 4.The helper does not take advantage of “power differential” in the helping relationship and recognizes extent of “vulnerability” of the helpee in the helping relationship. Case Studies will be used to help learners understand more fully the ethical process in establishing healthy boundaries in the helping relationship.


Learning Objectives

1. To identify and understand the basic moral principles involved in ethical thinking: 1. Autonomy; 2. Beneficence; 3. Non-maleficence; 4. Justice; 5. Fidelity; and 6. Veracity.


2. To identify specific guidelines for best practices for avoiding breaches of ethical, legal, professional and moral behaviors in the provision of their clinical responsibilities.


3. To identify common pitfalls or mistakes which contribute to poor boundary maintenance in the provision of clinical work in busy clinical settings.


4. To identify specific steps which professional helpers can take to limit their unknowingly breaching ethical standards, boundaries, or guidelines within their work as clinicians with individuals, couples and families as well as when providing supervision or consultation services.
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Maintaining Healthy Ethical Boundaries (CE Broker Tracking #: 20-615486)
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10 Cases for Boundary Related Issues Discussion

Do you have weak boundaries with your clients?

 

Directions: Read the following 10 statement to figure out if you have weak boundaries with your clients? On a scale of 1 to 10 rate how true each item is for you.  Use this scale:

 

1 = not at all true for me   5 = sometimes true for me 10 = always true for me

1. Do you find it impossible to say “no” to clients and/or clients’ families when they make a request of you which goes beyond what your responsibilities are for them?

 

2. Do you consistently believe that it is your duty to hold your clients and/or their families “together” even when the issues go beyond your job description?

 

3. Do you consistently feel on the defensive when people question the level of involvement you have with your clients and/or their families, especially when they say that they are afraid that you are overstepping your role with them?

 

4. Do you feel inside that you would feel guilty if you did not respond in some material way to the any needs which you identify your clients and/or their families have, even if the need goes beyond what your role and function is to be with them?

 

5. Do you feel it is your obligation to spend as much time and personal resources with your clients and/or their families that is possible since if you don’t who will help them meet their needs?

 

6. Do you have a problem standing up for your rights with your clients and/or their families when you feel that they are pressuring you to do more for them than what your job description calls for?

 

7. Do you tend to ignore the overly intrusive, smothering or “violating of your privacy behaviors” of your clients and/or their families so as to not feel the intensity of the hurt and uncomfortable feelings such violations cause for you?

 

8. Do you find it hard to draw the line with your clients and/or their families?

 

9. Do you have a problem separating yourself emotionally from your clients’ and/or their families’ pain and suffering?

 

10. Do you find yourself becoming resentful, with a chip on your shoulder when you feel that others are questioning how far you are going with your time, energy, and resources with your clients and/or their families?
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Professional Boundary Self-Assessment Form

Results: If you have rated 5 or more items with a rating of 5 or higher there is a strong possibility that you are maintaining weak boundaries with your clients and or their families.

 

What are Boundaries in Helping Relationships?

Boundaries:

  • Are the framework within which the helper-helpee relationship occurs. Helpees are also called Clients which term we will do for the rest of this presentation.
  • Make the relationship professional, and safe for the client
  • Set the parameters within which the helping services are delivered
  • Refer to the line between the self of the client and the self of the helper

Boundaries typically include:

  • length of a session
  • time of session
  • personal disclosure
  • limits regarding the use of touch
  • general tone of the professional relationship
  • fee setting (if this is not a pro-bono service)

 

What drives the setting and maintaining Healthy Boundaries in a Helping Relationship?

Boundaries must be set and maintained in the helping relationship to insure:

  • The helper does “No Harm” to the client in the helping process
  • The rights of the client are respected and honored
  • The helper is always respectful of and conscious of the need to guard the privacy of the client
  • The helper does not take advantage of and recognizes the extent of the “vulnerability” of the client in the situation

What are typical incidents in which boundaries with clients are blurred?

1. Dual Relationships: You cannot be both a helper and a “friend” or “significant other” to a client due to the reality that it is too easy to lose perspective in the helping of the client and the client loses perspective as to your real role in the client’s life if the relationship goes beyond the helper-client roles. The helper typically has a “power or authority” role with the client even if the helping service in not a fee-based service. It is important not to confuse the client in creating a confounded relationship where the roles become blurred and where expectations become magnified and the demands on the helper become magnified due to the demands and needs of the client who has been befriended and overly attached to the helper.

 

2. Becoming a Friend with Client: Even though the mere fact of providing “help” to another in need has the visual and emotional aspect of “friendship” it is important while the client is still in the helping relationship with you to maintain the boundary of no friendship. However once services are ended there is no prohibition to becoming a friend with an ex-client. The danger in becoming a friend while serving a client is that the emotional vulnerability of the client will become sensitized and if you should not be able to spend the amount of time or provide the amount of services which the client expects to receive from a friend there is situation which is ripe for conflict, hurt feelings and conceivably exacerbating the needs of the client who already was vulnerable and in need prior to this helping relationship being established.

 

3. Self-Disclosure: where the helper reveals very personal information about self with the client which sharing has no real purpose in the goals of meeting the needs of the client. In fact such self-disclosure take the spotlight off of the client’s issues and focuses rather on the helper. Unless there is a specific therapeutic positive outcome to be gained by self-disclosure the helper ought to avoid it. Remembering: When the helper is ready to disclose one must ask the question: Does the self-disclosure serve the client’s therapeutic goal? Unless you can justify the action, stay away from self-disclosing to maintain healthy boundary maintenance with the client.

 

4. Maintain Business-Like Helping Situation Protocols while providing help to the client. This means maintaining a professional relationship which includes: seeing the client only during work hours; seeing the client only in the “appropriate professional locations where the helping relationship is to be performed; only taking emergency phone calls from the client on rare occasion and not make nightly or weekly phone calls between client and helper a normal routine.

 

5. Not giving or receiving gifts of significant value between helpers and their clients. If such gift giving were to transpire, the client who gave the gift could expect “special” treatment from the helper and conversely the helper could feel “more obligated’ to go outside the norms of typical helping protocol to “pay back” the client for the client’s generosity in the gift given. To avoid such confusion in the future the rule would be to just abide by the "No Gift Giving" guideline.

Questions to Ask in determining Boundary Issues with Helpees

In each individual case, boundary issues may pose dilemmas for the clinician and there may be no clear or obvious answer. In determining how to proceed, consideration of the following questions may be helpful.

  • Is this in my client’s best interest?
  • Whose needs are being served?
  • Will this have an impact on the service I am delivering?
  • Should I make a note of my concerns or consult with a colleague?
  • How would this be viewed by the client’s family or significant other?
  • How would I feel telling a colleague about this?
  • Am I treating this client differently (e.g., appointment length, time of appointments, extent of personal disclosures)?
  • Does this client mean something special to me?
  • Am I taking advantage of the client?
  • Does this action benefit me rather than the client?
  • Am I comfortable in documenting this decision or behavior in the client file?
  • Does this go against the Standards of Professional Conduct or the Code of Ethics of my professional field?

Are you a Compulsive Fixer-Rescuer?

 

Directions: Read the following statements to figure out if you are a Compulsive Fixer and or Rescuer? On a scale of 1 to 10 rate how true this item is for you.  Use this scale:

 

1 = not at all true for me   5 = sometimes true for me 10 = always true for me

1. Do you want to help your clients and or their families to handle situations they find themselves in even when the clients or their families have not asked for your help?

 

2. Do you find that you really are trying to “fix” the lives of your clients and or their families when in fact there are many things in their lives which cannot be fixed and therefore you hit dead ends in your attempts to “fix” their unsolvable problems?

 

3. Do you find it hard not to “butt in” and offer your “two cents” in almost every situation your clients and or their families open up to tell you about?

 

4. Do you bristle or resent it when given feedback on your helping skills especially if the feedback is concerned about you possibly “burning out” due to your overextending yourself into the lives of your clients and or their families?

 

5. Have you ever questioned yourself as to why it is that you spend more time in your life in helping your clients and or their families achieve the things they need in their lives and yet you ignore and spend little time in meeting your own life needs?

 

6. Do you find that you are always ready with an answer or solution for anyone you come upon who is in major need even when the solutions are close to impossible to achieve given the dire nature of the clients’ and or their families’ needs?

 

7. Do you find yourself currently compulsively driven behavior to rescue or help your clients and their families to be the way you believe they should be?

 

8. Do you find yourself seeing your clients and or their families as in need and find your automatic response pattern to this reality it to fix it and make it better?

 

9. Do you believe that, unless everything is just right for your clients and or their families that then can never fully be happy in life?

 

10. Do you find yourself developing into an obsessive need to have everything in your clients and or their families’ lives to be perfect or correct in order for you to be comfortable enough to be relaxed and accepting of circumstances?          

 

11. Do you find yourself having an inability to accept your clients and or their families the way they are and then chronically attempting at changing them even if they are unchangeable?

 

12. Do you find yourself acting on the belief that you have more knowledge than your clients and or their families as to what is good for them so you strive to correct their thinking to see the light in your way?

 

13. Do you find yourself having an inability to maintain emotional detachment from the circumstances in your clients and or their families’ lives that are hurting or troublesome to witness so that you proceed to fix them even if this means that they are hindered from personal growth and accepting personal responsibility for their own actions?

 

14. Do you have an inability to not give advice, suggestions, or make offers of help, even when you know in doing so that it will hinder your clients and or their families’ growth and personal mastery in life?

 

15. Do you find yourself interfering in business and personal affairs to help your client clients and or their families even when they haven't asked for your help or assistance?

 

16. Do you find yourself driven to feel needed or wanted which leads you to become overly involved and overresponsible in your relationships with your clients and or their families? 

 

17. Do you see that you are caught up in a pattern of needing to get approval and recognition from your clients and or their families for helping with the belief that this is the only way you can have meaning in life?
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Self-Assessment of Compulsive Fixer/Rescuer Behaviors

Results: if you have answered 5 more items with scores of 5 or higher there is a strong possibility that you are maintaining weak boundaries with your clients and or their families due to being a compulsive fixer or rescuer.

The Helper’s Challenge in maintaining boundaries is to:
  • Be aware
  • Be self-aware of the feelings and behaviors involved in working with each client
  • Be observant of the behavior of other helpers in the field and call them on it if they appear to be overstepping their boundaries with clients
  • Always act in the best interest of the client
  • Most importantly DO NO HARM to your clients

So How Well Have You Learned to Maintain Boundaries?

Download the attached PowerPoint and take the 10 question test at the end of the powerpoint to determine how well have you learned about maintaining boundaries in professional helping relationships.

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Presentation on Maintaining Professional Boundaries with Pop Quiz at the end

Tools to Help You Maintain Boundaries

Resources in the Tools for Coping on www.coping.us to help address maintaining healthy boundaries and letting go of the need to be a compulsive rescuer, fixer or enabler.   

 

Overcoming the Need to Fix:

http://www.coping.us/toolsforhandlingcontrol/overcomeneedtofix.html

 

Tempering Idealism:

http://www.coping.us/toolsforhandlingcontrol/temperingidealism.html

 

Eliminating Caretaker Behaviors:

http://www.coping.us/toolsforhandlingcontrol/eliminatecaretakerbehaviors.html

 

Letting Go of the Uncontrollables and Unchangeables:

http://www.coping.us/toolsforhandlingcontrol/letgouncontrollablesunchang

 

Accepting Powerlessness:

http://www.coping.us/toolsforhandlingcontrol/acceptingpowerlessness.html

 

Developing Detachment: http://www.coping.us/toolsforhandlingcontrol/developingdetachment.html

 

Establishing Healthy Boundaries: http://www.coping.us/growingdown/healthyboundaries.html