On this basis, the risk-management value of avoiding even the appearance of boundary violations should be self-evident.
This communication has three goals: 1 ) to review the subject in order to define, describe, and illustrate the range of boundary issues, 2) to demonstrate that crossing certain boundaries may at times be salutary, at times neutral, and at times harmful, and 3) to suggest preventive and reparative measures for clinicians dealing with boundary violations in themselves and their patients. Is it too amorphous, protean, and abstract to define at all? Augustine was supposed to have said about time, "Time? Part of the difficulty encountered in defining appropriate boundaries can be related to the historical tradition that modern therapists have inherited.
The problem of the contradiction between what the master therapists wrote and how they actually behaved in the clinical setting was compounded because psychoanalysis and psychotherapy are treatments that occur in a highly private context.
The literature tends to focus on patient-therapist sexual misconduct (3) as an extreme violation and not on the wide variety of lesser and more complex boundary crossings, many of which are, at first glance, less obvious but pose difficulties of their own for clinicians.
Clinicians tend to feel that they understand the concept of boundaries instinctively, but using it in practice or explaining it to others is often challenging.
In its language here, the board clearly articulated its "inference" of fire from the "undisputed" presence of smoke.
Moreover, recent court decisions suggest a trend toward findings of liability for boundary violations even in the absence of sexual contact (7).
They selectively review the literature on the subject and identify critical areas that require explication in terms of harmful versus nonharmful boundary issues short of sexual misconduct.
Gabbard Abstract: The authors systematically examine the concept of boundaries and boundary violations in clinical practice, particularly as they relate to recent sexual misconduct litigation.When Melanie Klein was analyzing Clifford Scott, she encouraged him to follow her to the Black Forest for her holiday. Winnicott, another therapist of considerable stature, occasionally took young patients into his home as part of his treatment of them (10).Each day during this Vacation, Scott underwent analysis for a 2-hour session while reclining on Klein's bed in her hotel room (9). In Margaret Little's report of her analysis with Winnicott (1 1 ), she recalled how Winnicott held her hands clasped between his through many hours as she lay on the couch in a near psychotic state.However, modern clinicians should be aware of three principles that govern the relationship among boundaries, boundary crossings, boundary violations, and sexual misconduct.First, sexual misconduct usually begins with relatively minor boundary violations, which often show a crescendo pattern of increasing intrusion into the patient's space that culminates in sexual contact.Heightened awareness of the concepts of The concept of boundaries, particularly in the sense of boundary crossings and boundary violations, has come under increased scrutiny in relation to the wave of sexual misconduct cases (2) arising in litigation, ethics committee hearings, and complaints to boards of licensure.