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Maintaining Professional Boundaries

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Julia, the client, is seeking personal information from Michael, her practitioner, and suggesting meeting outside of appointment times, therefore challenging Michael's personal and professional boundaries. Julia seems to need a friend. The issues concerning this are:

* What are boundaries? Because of the personal nature of a helping relationship, there is a Code of Ethics that helpers abide to regarding ethics (Brammer & MacDonald 2003, p. 152) and maintaining clear professional boundaries is an important aspect of patient care (Galletly 2012, p. 380). Boundaries are essential to keep both the helper and the helpee safe, and are there to ensure that no outside factors intrude on the relationship or jeopardise the level of care being administered (Sarkar 2004).

* What are boundary crossings and are they appropriate? Boundary crossings are intentional or unintentional digressions across boundaries of the established limits of the professional relationship (Gabbard & Guthiel, 1993). Boundary crossings may arise from the practitioner or from the client, and no harmful effects are meant. An example is accepting a small gift from a client who wants to show their appreciation.

* Are boundary crossings the same as boundary violations? Boundary violations do imply harm to the patient (The Canadian Association for Parish Nursing Ministry 2012). They happen when boundaries are crossed, and are characterised by secrecy, role reversal and the practitioner's needs being met rather than the client's (Arizona State Board of Nursing 2012). An example would be excessive self-disclosure by the practitioner. Sexual relationships are always a boundary violation (Lazarus & Zur 2002 p. 46).

* What are dual relationships, and are they wrong? Dual relationships (or Multiple Relationships) are a subtype of boundary crossing (Zur Institute 2013) and deal with any situation where there multiple roles existing between a practitioner and their client (Zur 2006). Examples would be when the client is a friend of the practitioner They could also be a family member, an employee or a student (Zur Institute 2013). .

Even though the three articles are discussing maintaining professional boundaries in either psychology or counselling, the issues raised are still relevant in the natural health care setting.

Boundaries may be described as the outside limits of suitable professional behaviour (Aravind et al. 2012, p.21) and are maintained through the use of body language, words and behaviours. Boundaries characterise the conventional social distance between practitioners and their clients; they are lines which, if crossed, will constitute unprofessional behaviour and misuse of power (College of Dieticians of British Columbia 2010). The practitioner must avoid any situations with a client that could cause a conflict of interest (even inadvertently). This can be hard to do, given that boundaries are different for every person, they vary from one situation to another, and are apt to change over time (Australian Institute of Professional Counsellors 2010).

There are no guideline or ethics codes dealing specifically with boundary crossings, though all codes and guidelines have a mandate to avoid harming or exploiting the client; and respecting the clients' integrity and independence (Zur Institute 2013). Paving the way for boundary issues resulting in boundary crossings and violations (non-sexual and sexual) are the practitioners' ignorance, unscrupulous character, emotional vulnerability, moral weaknesses and similar (Aravind VK, Krishnaram VD & Thasneem Z 2012).

There are many proven interventions that are regarded as boundary crossings. Suitable boundary crossings can increase understanding and familiarity, and can help with feelings of connection. When done with the client's well-being in mind, boundary crossings can enhance the practitioner-client relationship and should



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