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| Applications of a Behavioral Developmental Theory of Therapist Behavior with Clients: Therapeutic Boundaries |
| Sunday, May 29, 2005 |
| 10:30 AM–11:50 AM |
| Lake Michigan (8th floor) |
| Area: DEV; Domain: Theory |
| Chair: Patrice Marie Miller (Salem State College) |
| Discussant: Thomas Gutheil (Harvard Medical School) |
| Abstract: From a behavioral-developmental point of view, a therapeutic boundary is a discrimination among stimuli. Therapist responses in the presence of a particular stimulus (or set of stimuli) are reinforced; such responses are seen as socially, legally, professionally, clinically and morally acceptable. Responses made in the presence of other stimuli are not reinforced (that is, it is not acceptable to respond). The behavioral- developmental aspect of this theory suggests that situations, and the tasks within them, can be ordered according to how complex they are and therefore how discriminable the contingencies are. Boundary violations are most likely to occur in situations in which the reinforcement contingencies are most difficult to discriminate. The behavioral-developmental view implies that potential boundaries are pervasive (boundaries occur in many situations, in all cultures). Therefore, boundary issues and questions are also pervasive and variable in different cultures or situations. The purpose of this symposium will be to discuss different types of boundary violations, and in particular to highlight how views may differ in different cultures and from different theoretical perspectives. Implications for practice will also be discussed. |
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| Clinicians’ Perceptions of Boundaries in Brazil and United States |
| PATRICE MARIE MILLER (Salem State College), Thomas Gutheil (Harvard Medical School) |
| Abstract: Although there has been considerable theoretical discussion of therapeutic boundary violations, little empirical research exists. This study compares perceptions of mental health professionals in Brazil and the United States of what may constitute possible boundary violations. Participants rated each possible boundary violation as to its degree of 1) harm, and 2) professional unacceptability. Three distinct groupings of boundary violations were found: a) Core Boundary Violations, consisting of the most serious violations, b) Separation of Therapist and Client Lives, involving encounters between therapists and clients outside of therapy, and c) Disclosure and Greeting Behaviors, involving disclosure of information about the therapist and greeting behaviors. The two cultures were found to be surprisingly similar, with only a few differences. A Rasch (1980) scale of the perceived seriousness of boundary crossings and violations is also presented. |
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| Differences in What Is a Boundary Violation for Traditional Therapists and Applied Behavior Analysts |
| MICHAEL LAMPORT COMMONS (Harvard Medical School) |
| Abstract: Martin H. Williams (1997) states that “hugging, dining with, self-disclosing to, or making house calls to patients are among behaviors which have been termed ‘boundary violations’ in psychotherapy. Although authors have asserted that boundary violations are both harmful and beneath the standard of care, some of the activities in question are consistent with the ethical practice of behavioral psychotherapies.” Based on a behavioral-developmental theory of boundary violations, we present a very simple way to understand whether or not a practice is a boundary violation – simply does it exploit the patient financially, sexually, etc. |
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| Avoiding Getting Sued over Boundary Issues |
| MICHAEL LAMPORT COMMONS (Harvard Medical School) |
| Abstract: People who get sued for boundary violations generally fall into two types: depressed, middle age males and people who are described as psychopathic in DSM IV. There are a number of traps that lead people to engage in boundary violations. They are failure to have a written treatment plan that is followed, practicing in a private manner without review or consultation, and failure to recognize behavioral transference – falling for the patient. Because behavioral treatment may involve activities outside of offices, and institutions, one must be careful in document the reasons for such activities. |
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