Policies, Procedures, and Other Important Info
Boundaries of Therapy
Over the course of therapy, you develop an intimate relationship with your therapist. This is natural, and part of what makes therapy so wonderful! Because of this intimacy, there are many guidelines and "rules" about therapy that I have to follow. Following these guidelines protects your therapeutic experience and allows you to get the most out of therapy.
The fundamental notion inherent in the concept of professional boundaries is that attention to the basic aspects of the professional nature of the therapeutic relationship will serve to create an atmosphere of safety and predictability that facilitates the client’s ability to use the treatment.
Characteristics of Professional Boundaries
Boundaries are the framework within which the therapist/client relationship occurs. Boundaries make the relationship professional, safe for the client, and set the parameters within which psychotherapeutic services are delivered. Professional boundaries typically include fee setting, length of a session, time of session, personal disclosure, limits regarding the use of touch, and the general tone of the professional relationship. In a more subtle fashion, the boundary can refer to the line between the self of the client and the self of the therapist.
Boundary considerations often are not clear-cut matters of right and wrong. Rather, they are dependent upon many factors and require careful thinking through of all the issues, always keeping in mind the best interests of the client.
Boundaries do not exist to communicate coldness or aloofness. They are structural characteristics of the relationship that allow the therapist to interact with warmth, empathy and spontaneity within certain conditions that create a climate of safety. It is only by virtue of the fact that the therapist-patient relationship will never be anything but professional that patients can speak freely about all of their problems.
Who Negotiates the Boundaries in the Professional Relationship
In any professional relationship there is an inherent power imbalance. The therapist’s power arises from the client’s trust that the therapist has the expertise to help with his or her problems, and the client’s disclosure of personal information that would not normally be revealed. The fact that services cannot be provided unless clients are willing to cooperate, does not change the fundamental power imbalance. Therefore, the therapist has a fiduciary duty to act in the best interest of the client, and is ultimately responsible for managing boundary issues and is therefore accountable should violations occur.
Self-disclosure: Although in some cases self-disclosure may be appropriate, I usually do not share much about my personal life with my clients. The main reason for this is to respect the professional relationship and to be sure the focus of the session remains on YOU, the client.
Dual and overlapping relationships: The term dual relationship in psychotherapy refers to any situation where dual or multiple roles exist between a therapist and a client. This refers to the situations where there is a secondary relationship between therapist and client in addition to the therapeutic one.
Personal Relationships: While our relationship will become close, and friendly, it is not the same thing as a friendship. I cannot have a social relationship with you and be your therapist; this would be a violation of my professional ethics.
Similarly, talking about sexual thoughts and feelings is often a part of therapy for many individuals. While it is normal for some clients to experience brief periods where they wish they could be closer to their therapist, this is not the same thing as acting on those feelings. Actual sexual relations between clients and therapist is never okay. Knowing this helps a lot of people feel safer when they discuss sexual issues.
Incidental Encounters: If I become your therapist, this is confidential, which means I cannot acknowledge you are my client to anyone unless I have a signed authorization. Therefore, if we happen to meet out in town, it is up to you if you would like to acknowledge me. I will most likely keep my end of the conversation to a minimum so as not to accidentally reveal anything confidential. It will be up to you to inform anyone you may be with how you know me.
Bartering for Services: The only form of payment for services can be monetary. It is illegal for a therapist to accept payment for therapy with professional or personal services. Also, a therapist is not allowed to accept any professional or personal services from clients.
Advice: Therapy is a process of exploration. While practical suggestions about coping skills or referrals are a natural part of therapy, my primary role is not to give you advice about what to do in your life. Therapy is about helping you come up with your own solutions. If I do give advice, please know it is like the fitting of two pieces of a puzzle; YOU have to decide if it “fits” you and your life.
Confidentiality
Is the information discussed in therapy kept private? You have a right to expect absolute privacy and confidentiality in therapy. Without your explicit consent, the therapist is prevented by law from discussing information you share during your sessions with anyone else. Knowing and trusting that anything you say will be safely contained in the therapeutic space is essential to meaningful therapy.
Are there ever instances in which the therapist does reveal what a client tells them? There are some limitations to confidentiality in therapy. The legal system acknowledges that there are times when the client, society or both can benefit from release of information. The circumstances in which confidentiality can be breached are defined by State and Federal case law. The most common circumstances include:
Danger to self or others: All states allow a therapist to reveal the name of a client who is deemed a real and present danger to self (e.g., suicide) or others. Some states even require that the therapist warn or attempt to protect the person against whom the threats are being made.
Abuse of children, elderly, or mentally or physically handicapped: In most states a therapist is required to report credible knowledge of current or past abuse. This applies to situations in which the client is the one who was abused as well as to situations in which the client is the abuser.
Third-party reimbursement: If your insurance coverage pays for any of the costs of your therapy, you are giving your consent for information such as your diagnosis and appointment dates to be shared with your insurance company.
Collection of debt: If you fail to settle an account balance for your therapeutic treatment, your name and the amount you owe can be made known to a collection agency. Defense of malpractice or professional complaint: If you were to allege that your therapist engaged in malpractice or some other unethical act, the therapist has the right to disclose information from your sessions in their defense of your charges.
Read my Confidentiality Agreement (Adult clients)
Read my Confidentiality Agreement (Child clients)
Other Policies
No Secrets Policy: In family or couples therapy, I will always have a "no secrets" policy. This means that whatever is said by one member in therapy, all members need to be made aware of the information. The exceptions to this include safety issues. Child abuse, domestic violence and other violence in a relationship cannot be treated jointly, for safety reasons. I can only treat one member and offer you referrals for other parties to deal with these issues.
Parents Paying for Therapy of a Child: If your child is under the age of 12, you (by law) have the right to know what treatment I am providing to your child and what is happening in your child's therapy. However, this law can impair your child's treatment. Therefore, I ask parents to respect their child's confidentiality. Sometimes children need to feel that they can tell something to their therapist that won't be told back to their parents and this is the only way that therapy will be successful. If there is something that is happening in your child's life that is dangerous, I will inform you. Safety is always a priority. If something comes up that I perceive to be important but not dangerous, I often encourage children to talk with their parents about it, usually in my presence. This allows them to talk openly in a safe, structured environment as well as practice communicating with their parents.