BOUNDARY VIOLATIONS --- CROSSING THE LINE

 

 

Boundary violation cases are increasing in number._ Separate and apart from cases involving undue familiarity/sexual contact with a patient; boundary violations are tougher to appreciate._ As social mores have become more diluted, boundaries have become more difficult to properly maintain. Often it is hard to tell where the boundary line lies._

 

Maintaining proper boundaries is especially difficult with manipulative patients or those with personality disorders._ Many times a therapist's heart is in the right place, but nevertheless, there is a boundary violation._

 

Be careful to maintain a proper professional relationship with the patient._ In order to preserve strict boundaries, do not have a social or employment relationship with patients._ Don't lend patients money, don't buy or sell any items to patients. Don't meet patients for lunch._ Never accept any gifts from patients.

 

Clinicians are so enmeshed in their patients' daily lives, often the patient loses sight that the therapist should not be considered a friend, but a professional clinician._ Be careful of transference and counter-transference issues._ Should a therapist accept an invitation to a patient's wedding?_ Should a therapist accept Cubs tickets from a patient?_ Should a therapist use a patient's time-share vacation home?

 

The following are case studies of various boundary violations we have encountered in our practice.  

 

 

THERAPIST MAKING HOUSE CALLS

A patient was too depressed to come to the clinician's office._ The clinician felt the patient needed therapy and decided to make a house call._ The therapist continued to make house calls for many months._ Eventually, the clinician was sued for boundary violations including undue familiarity. 

 

PATIENT IS EMPLOYED TO DO SOME OFFICE WORK 

A patient suffering from Borderline Personality Disorder continues to hang around the mental health clinic for hours at a time, even when she does not have an appointment._ The clinic director cannot get her to leave the waiting room._ The director decides to give the patient some "envelope stuffing" and other filing work around the clinic._ The director thinks that as long as the patient is hanging around, she might as well put her time to good use._ The clinic was sued for boundary violations.

 

CLINICIAN IS A MATCHMAKER 

A therapist has two patients who seem perfect for one another.  The therapist feels that it would be beneficial to both of them to meet and possibly date.  Accordingly, the clinician makes a match and "hooks them up."_ The date and subsequent relationship seem to work out well.  Unfortunately, the relationship falls apart and both patients sue the clinician. 

 

USING THE OFFICE FOR OTHER PURPOSES  

The therapist decides to hold a poker game in his office with some friends and some patients.  The poker game seems innocent enough until a patient starts to lose his money.  The patient sues and the clinician doesn't have the winning hand. A clinician's office should only be used for therapy.

 

BUT SHE'S NOT MY PATIENT  

The clinician meets a woman at a health club. After working out, he decides to invite her back to his office. They have sexual relations in that office for years.  When the relationship finally ends, she sues the clinician for malpractice claiming her "therapist" had a sexual relationship with her.  The clinician argues that the woman was never a "patient" and the relationship was between consenting adults.  Although the clinician is technically correct, he loses the lawsuit because there was an "appearance" of a therapist/patient relationship.