Boundaries in psychotherapy: model guidelines

THE maintenance of boundaries in psychotherapy is now one of the most critical areas of ethical inquiry for psychiatrists and other mental health professionals. Sexual contact between therapists and patients-the most egregious example of boundary violation-has received a good deal of attention (Gabbard 1994), and a firm consensus regarding its inappropriateness has developed (American Psychiatric Association 1992b; American Psychological Association 1992). But public concern over nonsexual boundary violations is growing, as witnessed by highly publicized cases in the media (Kagan 1988; Karel 1993), rulings by licensure bodies (In the Matter of Aronoff 1992), and lawsuits (Jorgenson and Sutherland 1993). Evidence from all of these sources suggests that the task of defining appropriate boundaries in psychotherapy is complex and confusing for therapists, regulators, and the public alike.