The therapeutic alliance concept, which involves the bond that is felt between the client and the therapist, is the most important factor in the process of psychological and emotional recovery. In this concept, there is a deliberate collaborative relationship between those two parties for the purpose of positive therapeutic progress. There are numerous studies that show how the power of the therapeutic alliance concept can affect the wellbeing of an individual (Ginory, Sabatier & Eth, 2012). This concept involves the use of verbal and non-verbal behaviors which empower the confidence of the client. Behaviors such as empathy, understanding, and warmth foster the development of the therapeutic alliance. In addition to that, these behaviors are important in validating the client and assisting the therapist in detecting the obstacles that may arise during therapy (Ginory, Sabatier & Eth, 2012). Through these behaviors, therapists are able to convey to their clients that they are involved in the process and really listening. In most cases, the therapeutic alliance is stronger between clients and therapists who have worked together for long. For example, treating clients for several years enables a therapist to know them well and develop relationships with deep connections.
A therapist has to understand the difference between a professional relationship and a personal relationship. If these two types of relationships are not separated, then a therapist may not tell when the boundary between the two is crossed. There are some behaviors, however, which are not acceptable in the relationship between the therapist and the client (Pugh, 2007). For example, a therapeutic alliance that leads to physical or emotional abuse violates the boundaries of therapeutic relationships. Other types of inappropriate behavior that may indicate a violation of the boundary include romantic encounters and sexual relations between a therapist and a client. Although it is professionally beneficial for therapists to form strong bonds with their clients, there is a need to ensure that the limits of those bonds are not violated. Professional boundaries are, therefore, put in place to ensure that the limits for the therapeutic alliance are clearly defined. Therefore, there is a risk in having personal and professional relationships with a client simultaneously (Ginory, Sabatier & Eth, 2012).
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It is possible to practice effective and objective family therapy in the therapeutic alliance concept without crossing the professional boundaries. One of the ways that this can be achieved is by separating all the aspects of personal and professional relationships. For example, the location of therapy sessions has to be confined to the treatment area. This setting ensures that all interaction during the treatment sessions remains professional. In addition to that, the professional has to ensure that the power balance in the therapy is not distorted. Here, the professional has to remain empowered by the professional skills and respect the private information provided by the client. The purpose of the relationship has to remain on providing care to the client. Although the two parties may have a long-running relationship, it is the responsibility of the professional to ensure that the relationship does not affect this purpose (Ginory, Sabatier & Eth, 2012).
Practicing effective family therapy without crossing borders in the therapeutic relationship needs clarification of the roles of the professional. The therapist should set the stage by establishing appropriate boundaries during the initial assessment of the client. The needs of the client should always be placed first and remain at the core of the practice. The trust and respect between the two parties have to remain intact irrespective of the level of the therapeutic alliance between them. The client trusts that the professional has the appropriate skills, knowledge, and abilities to provide care that leads to successful assessment or treatment. In addition to that, it is the responsibility of the therapist to respect the client regardless of sexual orientation, age, gender, religion, race, or social status. If all these aspects are observed, then a healthy therapeutic relationship can be established (Pugh, 2007).
It is the responsibility of the therapist to use clinical judgment in the determination of professional boundaries. However, this can be a difficult endeavor since different situations and individuals may have different boundaries. Therefore, the therapist will have to utilize skills and experience to practice objective family therapy without crossing those boundaries. Although professional boundaries in family therapy are dynamic, there are some behaviors that can be said to be in clear violation of therapeutic relationships and hence should be avoided. For example, swearing, teasing, using cultural slurs, sarcasm, and intimidation are never acceptable. The use of inappropriate tones or expressions that show exasperation or impatience is not appropriate in therapeutic relationships (Ginory, Sabatier & Eth, 2012). It is, therefore, important to avoid this type of behavior in order to practice effective family therapy.
Professional judgment and careful contextual consideration are useful, especially in the grey areas around professional boundaries. For example, hugging a client may be considered to be appropriate and healthy behavior. However, when the occurrences of such behavior are put together they may form a pattern indicating the crossing of the professional boundary. In such situations, the professional must ensure that the context of any type of behavior is carefully considered. Feeling uneasy during a session with a client may be an indication that a boundary was crossed either party, hence creating the need for addressing such tension to make the treatment sessions comfortable for all. The therapist must also be aware of some innocent and isolated comments and disclosures that may lead to the crossing of the professional boundary (Ginory, Sabatier & Eth, 2012).
Another way that a professional can practice effective and objective therapy without violating professional boundaries is by observing and adhering to the professional practices that establish a healthy therapeutic alliance. For example, clients should be addressed by their preferred titles or names. Listening to the client should also be done in a professional and non-judgmental way. In addition to that, the therapist should be aware of attitudes, behaviors, and comments that may cause discomfort and negatively affect the therapeutic alliance. Although some comments from the therapist can be seemingly harmless, they can take the therapy sessions into uncomfortable territories, and hence should be corrected immediately (Pugh, 2007). Furthermore, the therapist should always reflect on the interactions with the client to see if they fall within the professional boundaries.
Reflections on the interactions with clients can help identify behaviors that may blur the professional boundaries meant to protect the client. There are several behaviors that can blur the boundaries without necessarily having to cross them (Pugh, 2007). For example, spending time with a client beyond the specifications of the therapeutic session can be an indication that the professional boundary is about to be crossed. Others include sharing personal issues with clients, responding to personal overtures made by clients in sessions, choosing clients based on gender or age, as well as dressing differently when attending to a particular client. Maintaining treatment longer than the required time and being defensive when discussing interactions with clients are other indicators of blurred boundaries. The identification of these behaviors that blur the professional boundary can be useful in re-establishing an effective therapeutic alliance. It is the duty of the therapist to monitor and maintain professional limits with clients in order to achieve effective family therapy (Pugh, 2007).
References
Ginory, A., Sabatier, L. M., & Eth, S. (2012). Addressing Therapeutic Boundaries in Social
Networking. Psychiatry, 75 (1).
Pugh, R. (2007). Dual Relationships: Personal and Professional Boundaries in Rural Social
Work. British Journal of Social Work, 37 , 1405- 1423. doi:10.1093/bjsw/bcl088.
