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Doody's Review ServiceReviewer: Christopher J Graver, PhD, ABPP-CN(Madigan Healthcare System)
Description: Having sexual relations with a patient is an obvious boundary violation for clinicians, but what about accepting a gift, receiving a hug, or saying hello in the supermarket? This book explores potential boundary violations that occur commonly in clinical practice and discusses the ways in which clinicians can address them in a therapeutic context.
Purpose: The main purpose is provide clinicians with very practical information about boundary violations and how to handle them from legal, ethical, and professional standpoints.
Audience: This book is appropriate for anyone working in a patient care role, such as psychologists, other mental health professionals, social workers, occupational and physical therapists, physicians, and many others. For students and those supervising trainees, this will be a particularly helpful book. The authors are involved in this area in their scholarly work.
Features: An introduction to boundaries begins the book, followed by a discussion in the second chapter of the limits of therapy and the therapist's role. The book presents a multitude of situations that emphasize clinician/patient boundaries and the potential for violating those boundaries. Some of these situations include gifts/services, self disclosure, public meetings, physical contact, and sexual misconduct. These situations are discussed within the framework of ethical guidelines, as well as contextual factors relevant to the ethics of the situation. The book eschews a black-and-white perspective gleaned from rules and regulations, instead embracing the complexity and ambiguity of these situations. This is especially helpful for clinicians to truly understand the need for rational and ethical problem-solving, rather than relying on a strict memorization of ethical codes. Case examples illustrate the ambiguity and decision-making process that might underlie such behaviors related to boundaries. The final section addresses the importance of boundaries in clinical practice and the liability associated with violations. The final chapter offers important suggestions for the prevention of boundary violations, such as documentation, consultation, peer support, education, and training. The references are current and the index is detailed.
Assessment: This book gets to the heart of boundary violations in a sensible manner. The most valuable attribute of the book is that it helps clinicians engage in rational thought about potential violations before they occur and prepare ways to handle such situations when they arise, rather than just regurgitating ethical standards. It is refreshing to see a sincere discussion of this critical yet deficient area of clinical training.