In considering the uses and abuses of therapeutic boundaries, the therapist, as you know, must guard against implicit promises, which often are not consciously dishonest, but nevertheless may be unrealistic.
♦ Here are 3 Examples of Implicit Promises:
1. Have you ever found yourself making the following implicit promises? By this I mean, implicitly promising more than can be delivered in the context of the therapy setting, by indicating, for example, trust me, reveal yourself to me, and all is well.
2. How about this one? Attempting to pretend a false acceptance of, for example, the client's lifestyle. This may be destructive to the client's capacity to be honest and to trust in a therapy setting.
3. A third example of promises is found by implying that the relationship is permanent when in reality the client's therapist may change many times in the course of a helping endeavor, especially if the client is involved with the courts and the bureaucratic funding structure.
Let's now shift focus away from boundaries issues and client promises and talk about setting ethical boundaries regarding confrontation. Confrontation may be described as laying the cards on the table and looking at them as they are. As you know, it is not a hostile technique, but a facing of reality. You can confront your client with the reality of the situation. You may also confront them with their feelings and behavior patterns that are destructive. The therapeutic tool of confrontation may also be used to help focus your client's responsibility for his or her actions, as well as responsibility for his or her successes as well as failures.
In cases of child abuse... the parents are either unable or unwilling to meet their children's basic physical and psychological needs. If your assessment suggests that the parent fails to meet the child's needs and the parent is either not attached to the child or unhealthily attached to the child, it becomes necessary to set an ethical boundary regarding confrontational questions about abuse and neglect. I found it safest to move into this topic by exploring:
-- 1. First, whether the parents had concerns about their relationship with their child or about their parenting behavior and skills.
-- 2. Second, I follow this up with questions about whether others, like teachers or physicians, have ever expressed concerns.
-- 3. Thirdly, I express my concern about the patterns that have been revealed.
-- 4. Fourth and finally, I then explain that my concern is great enough to warrant some direct questions about abuse and neglect.
By following this flow from the general to the specific, I feel I maintain an ethical boundary between being inappropriately confrontational and being straightforward. Once this transition to the more specific has taken place, I go to more direct inquiries about specific incidents in the past if the information is not available.
♦ Heather's Confrontational Boundary
Here's a sample of how this confrontational boundary works. The parent, Heather, accused of child abuse, asks, "Are you accusing me of something here?" I state, "I suppose I have concerns about you leaving Mary home alone at her age. I believe that you are neglecting her needs for physical safety and supervision. At 8 years old she isn't really able to handle crises yet. A child her age does not yet have the ability to think on her feet."
Heather interrupts, "Mary is mature for an 8 year old." I state, "That just isn't enough to keep her safe. What do you suppose might have happened if your neighbor hadn't noticed the stranger in your backyard and hadn't called the police? After all, they did take him in because he was someone they had been looking for in a criminal case." Do you see how the flow of the confrontation boundary goes from general to more specific examples?
- Reamer, F. G. (2001). Tangled Relationships: Managing Boundaries in the Human Services. New York: Columbia University Press.
Peer-Reviewed Journal Article References:
Conlin, W. E., & Boness, C. L. (2019). Ethical considerations for addressing distorted beliefs in psychotherapy. Psychotherapy, 56(4), 449–458.
Montes, S. D., & Zweig, D. (2009). Do promises matter? An exploration of the role of promises in psychological contract breach. Journal of Applied Psychology, 94(5), 1243–1260.
Muran, J. C., & Eubanks, C. F. (2020). Therapist performance under pressure: Negotiating emotion, difference, and rupture. American Psychological Association.
Nissen-Lie, H. A., Orlinsky, D. E., & Rønnestad, M. H. (2021). The emotionally burdened psychotherapist: Personal and situational risk factors. Professional Psychology: Research and Practice. Advance online publication.
Sheeran, P., Bosch, J. A., Crombez, G., Hall, P. A., Harris, J. L., Papies, E. K., & Wiers, R. W. (2016). Implicit processes in health psychology: Diversity and promise. Health Psychology, 35(8), 761–766.
Ethics CEU QUESTION
What is one method to maintain an ethical boundary between being inappropriately
confrontational and being straight forward? To select and enter your answer go