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The breakdown of therapeutic boundaries, referred to as the “the slippery slope,” is often subtle and gradual and thus can be difficult to detect and understand. Many behaviors of a potentially abusive therapist may be appropriate in a healthy therapy. For example, a therapist may appropriately, from time to time, use his/her personal experiences to illustrate a therapeutic point. A therapist may also be willing to cut fees as a way of accommodating your limited budget. A therapist may even occasionally accept a small gift from you, so long as the purpose and meaning of the gift are explored and understood. The frequency and intensity of these behaviors may mark the difference between safe and unsafe therapeutic boundaries. The following boundary violations are danger signs that something may be seriously amiss in therapy. When these or other behaviors that make you uncomfortable occur, do not hesitate to question what is taking place, express your discomfort, and, by all means, seek an outside opinion. In addition, ask the therapist to stop the behavior: Tell a friend or family member what is happening: Keep careful notes on what is happening, along with all cancelled checks, insurance payment notifications, answering machine tapes of calls from the therapist, and gifts she/he has given you. If any of these behaviors continue, terminate immediately and file a complaint: The therapist talks about his/her personal problems, including sexual relations with others. The therapist makes sexual or suggestive jokes. The therapist asks questions about your sex life when you are talking about an unrelated issue. The therapist suggests seeing you outside the office or professional setting (e.g., dinner, movies, home visit). The therapist offers to cut fees, see you for extended sessions with or without fee, and wants to reschedule you to be the last patient of the day. The therapist tells you not to talk about your therapy with anyone else, that therapy is a secret. The therapist talks to you about his/her other patients. The therapist tells you, explicitly or implicitly, to stay away from friends and family. The therapist touches, fondles, hugs, or otherwise makes overt physical contact with you. The therapist offers food, alcohol, or drugs. The therapist gives you gifts or accepts them from you without discussion about their meaning. The therapist suggests that you trust him/her absolutely. The therapist asks you to work for him/her or solicits your advice on business, investing, or other area of your expertise. The therapist requests detailed information on your finances. The therapist uses fines or other types of punishment for infraction of his/her imposed rules. The therapist seeks to borrow money, your car, or other of your belongings. The therapist shows up at your house or suggests that your house would be an appropriate place to meet. The therapist tries to get you together socially or romantically with his/her other patients. The therapist threatens you in any way, such as the threat to tell others -- including your family members -- about you, to say that you’re crazy or to reveal confidences you have shared in the therapeutic context. The therapist promises to be your caretaker and/or to protect you from others. The therapist justifies any of the above behaviors by telling you that you are special, that he/she has never felt this way about a patient before, and that the boundary violations occurring are okay because of the special and different nature of your relationship. When you express discomfort with any of the above, or any aspect of therapy, the therapist becomes angry and/or tells you this is your problem and/or part of your illness, rather than discussing your discomfort openly. To return to the list of Essays, click here. |
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