Running head: BOUNDARY ISSUES IN HUMAN SERVICES

BOUNDARY ISSUES IN HUMAN SERVICES

Literature Review

Presented to

Jennifer Saxton

Arkansas Tech University

PS 4003

Capstone Project

By

Raven Blansett

T01200245

April 9, 2017
BOUNDARY ISSUES IN HUMAN SERVICES2

Introduction

The field of mental health is faced with many issues, the most prominent and unclear

issue being boundaries. Health care professionals are expected to uphold high ethical standards.

This is not always easy to do. Professionals from small communities find themselves running

into patients at community events or even at the grocery store. Human services professionals are

conflicted with social interactions with patients, responding to patient gifts, and use of social

media. Boundary issues have been in question for many years, but little empirical research was

done until the early 1980s and literature on the subject has continued to increase over the years.

A clear definition or guideline has not been established for professionals to abide by. Reamer

(2012) defines boundary issues emerging when professionals are confronted with potential or

actual conflicts with their professional responsibilities and their religious, social, business, or

collegial relationships. Some boundary crossings are not unethical and can have positive results.

This review covers a few of the types of boundary issues health professionals may face and ways

to prepare themselves to minimize the chances of unethical boundary issues occurring.

Literature Review

Health professionals can limit the chances of unethical relationships developing or other

boundary crossings by developing their own guidelines and policies. These should acknowledge

the professionals expectations from patients. It should also include what the patients can expect

as a reaction from the professional if one of these policies or guidelines is not adhered to. For

example, if a patient was to give the professional a gift, the policies and guidelines should

include how the professional is unable to accept such things. These should be discussed with

patients at the beginning of treatment to alleviate any misunderstandings.

BOUNDARY ISSUES IN HUMAN SERVICES3

Having clear guidelines can allow health service professionals to offer their patients the

most sincere and beneficial assistance. Most professionals look to their trades Code of Ethics

for guidance. Per Jungers and Gregoire (2013), these codes help to guide professionals to the

best possible decisions in the most jeopardizing situations. Becoming familiar with the Code of

Ethics can increase ones knowledge on what to do to avoid boundary issues. It can also give

understanding to which situations can be positive involvements, or boundary crossings, between

patient and professional.

When entering decisions that involve boundary crossings, professionals need to keep in

mind what effect their role has on patients. Kozlowski, Pruitt, DeWalt, and Knox (2014)

identified in their study of supervisors and supervisees that most supervisors are unaware of their

power over the latter. Like that of supervisors, health service professionals must be aware of

what power they have over their patients and take into consideration how their actions might be

interpreted. Actions that may seem harmless to one party can lead to the beginnings of

inappropriate relationships. One gateway that could easily lead to a boundary issue is social

media.

According to Social Media Statistics (2008), 8.4 million people use the social media site

Facebook. Social media can provide a safe and secure place for patients to receive healthcare

services such as counseling. Leibert, Archer, Munson, and York (2006) discovered in their study

why patients were pleased with online counseling. Reasons included anonymity, convenience,

ability to edit communication, and the cost. Professionals must have guidelines for online

services too. The key to avoiding boundary issues in this setting is keeping logs of all

communications with patients and only using accounts associated with the profession. If a

professional begins using their personal accounts, misinterpretations can occur and can lead to
BOUNDARY ISSUES IN HUMAN SERVICES4

unethical boundary issues. Making unsolicited visits to patients social media pages should be

avoided. Professionals should only use their professional titles when sending communication to

patients. It is also suggested to have privacy settings on personal accounts to avoid patients from

viewing personal posts and other information. The current American Counseling Association

Code of Ethics (2014) does not prohibit dual relationships, but precaution should be taken by

professionals when friending or allowing patients access to their social media pages.

Professionals must educate themselves on the laws and regulations of their patients

residence. In turn, they must educate their patients on these limitations and legal rights. Each

state may differ from one another on what is allowed or what is considered protected by privacy

laws. International services are also governed by different laws and regulations. Being up to

date on these can significantly decrease the chances of boundary issues of online or in person

services.

When faced with an ethical dilemma or boundary issue, healthcare service professionals

should document all occurrences and every action taken to solve the matter. Documentation can

increase the chances of success and minimize future occurrences from developing. If a

professional is fearful of a possible boundary issue, consultation with other professionals or state

or national committees is recommended.

Conclusion

The ultimate focus of relationships between professionals and patients should be to

decide if it benefits the patient in a positive and healthy way. As stated earlier, not all

relationships are bad and some can be beneficial to the patient. Professionals should take the

time to consider every aspect of the relationship and the diagnosis of their patients. These factors
BOUNDARY ISSUES IN HUMAN SERVICES5

may help predict the benefits or harm the relationship can produce. Professionals should stay

current on the standards and recommendations of their codes that are freely accessible.
BOUNDARY ISSUES IN HUMAN SERVICES6

References
American Counseling Association. (2014). ACA Code of Ethics. Alexandria, VA: ACA
Governing Council. Retrieved April 14, 2017, from
https://www.counseling.org/Resources/aca-code-of-ethics.pdf
Jungers, C. M., & Gregoire, J. (2013). Counseling Ethics: Philosophical and Professional
Foundations (1st Ed. ed.). Danvers, MA: Springer Publishing Company. Retrieved April
13, 2017, from
http://libcatalog.atu.edu:2090/ehost/ebookviewer/ebook/bmxlYmtfXzQ4NTY1M19fQU4
1?sid=c9d127fa-8573-4468-8b38-
02aa260d1c32@sessionmgr101&vid=0&format=EB&rid=1
Kozlowski, J. M., Pruitt, N. T., DeWalt, T. A., & Knox, S. (2014, June). Can Boundary Crossings
in Clinical Supervisoin Be Beneficial? Counselling Psychology Quarterly, 27(2), 109-
126. Retrieved April 13, 2017, from
http://libcatalog.atu.edu:2090/ehost/pdfviewer/pdfviewer?sid=9cfa64ce-d2db-4e2f-9ea9-
9c6837228590%40sessionmgr103&vid=1&hid=124
Leibert, T., Archer, J. J., Munson, J., & York, G. (2006, January). An Exploratory Study of Client
Perceptions of Internet Counseling and the Theraputic Alliance. Journal of Mental
Health Counseling, 28(1), 69-83. Retrieved April 14, 2017, from
http://libcatalog.atu.edu:2083/docview/198720837?rfr_id=info%3Axri%2Fsid%3Aprimo
Reamer, F. G. (2012). Boundary Issues and Dual Relationships in the Human Services (2nd ed.).
New York, NY: Columbia University Press. Retrieved April 9, 2017, from
http://libcatalog.atu.edu:2090/ehost/ebookviewer/ebook/bmxlYmtfXzQ4MTM1Ml9fQU4
1?sid=33e7a97c-f4cf-480a-bced-
c6cb41507376@sessionmgr101&vid=0&format=EB&rid=1
Social Media Statistics. (2008, July 22). Retrieved April 14, 2017, from Wikidot:
http://socialmediastatistics.wikidot.com/facebook