Sage Journals: Discover world-class research

Abstract

Behavioral health professionals are constantly faced with the dilemma of how to define boundaries in their relationships with clients. When working with groups from diverse cultures, defining boundaries becomes even more complex. This article urges a flexible approach, using the graded-risk model (Martinez, 2000) and a list of cultural factors for clinicians to consider. Possible benefits of reaching out to clients in concrete ways, as well as risks, are emphasized. Clients’ notions of appropriate boundaries must be considered in the decision-making process. Case examples from a refugee mental health clinic are used to elucidate a flexible approach to boundary decisions.

Keywords

boundaries culture doctor–patient relationship professional ethics professional misconduct psychotherapy

Get full access to this article

View all access options for this article.

References

Backlar, P. (2002). Roles, relationships, and rules: Boundary concerns. In P. Backlar & D. L. Cutler (Eds.), Ethics in community mental health care: Commonplace concerns (pp. 43–49). New York: Kluwer Academic/Plenum Publishers .

Blatt, S. J. (2001). Commentary: The therapeutic process and professional boundary guidelines . Journal of the American Academy of Psychiatry & the Law, 29(3), 290–293 .

Combs, G. , & Freedman, J. (2002). Relationships, not boundaries . Theoretical Medicine, 23(3), 203–217 .

Gabbard, G. O. (1999). Boundary violations in psychiatric ethics. In S. Bloch , P. Chodoff , & S. A. Green (Eds.), Psychiatric ethics (pp. 141–160). New York: Oxford University Press .

Gabbard, G. O. , & Nadelson, C. (1995). Professional boundaries in the physician–patient relationship . Journal of the American Medical Association, 273, 1445–1449 .

Gutheil, G. T. , & Gabbard, G. O. (1993). The concept of boundaries in clinical practice: Theoretical and risk-management dimensions . American Journal of Psychiatry, 150(2), 188–196 .

Gutheil, G. T. , & Gabbard, G. O. (1998). Misuses and misunderstandings of boundary theory in clinical and regulatory settings . American Journal of Psychiatry, 155, 409–414 .

Kinzie, J. D. (1980). An Indochinese refugee psychiatric clinic: Culturally accepted treatment approaches . American Journal of Psychiatry, 137(11), 1429–1432 .

Kinzie, J. D. (2001). Psychotherapy for massively traumatized refugees: The therapist variable . American Journal of Psychotherapy, 55(4), 475–490 .

10.

Kirmayer, L. J. (2000). Broken narratives: Clinical encounters and the poetics of illness experience. In C. Mattingly & L. Garro (Eds.), Narrative and the cultural construction of illness and healing (pp. 153–180). Berkeley, CA: University of California Press .

11.

Kirmayer, L. J. (2003). Asklepian dreams: The ethos of the wounded-healer in the clinical encounter . Transcultural Psychiatry, 40(2), 248–277 .

12.

Kroll, J. (2001). Boundary violations: A culture-bound syndrome . Journal of the American Academy of Psychiatry & the Law, 29(3), 274–283 .

13.

Lazarus, A. A. (1994). How certain boundaries and ethics diminish therapeutic effectiveness . Ethics & Behavior, 4(3), 255–261 .

14.

Martinez, R. (2000). A model for boundary dilemmas: Ethical decision-making in the patient–professional relationship . Ethical Human Sciences & Services, 2(1), 43–61 .

15.

Martinez, R. (2002). Narrative understanding and methods in psychiatry and behavioral health. In R. Charon & M. Montello (Eds.), Stories matter: The role of narrative in medical ethics (pp. 126–137). New York: Routledge .

16.

Radden, J. (2001). Boundary violation ethics: Some conceptual clarifications . Journal of the American Academy of Psychiatry & the Law, 29(3), 319–326 .

17.

Simon, R. I. (1999). Therapist–patient sex: From boundary violations to sexual misconduct . The Psychiatric Clinics of North America, 22(1), 31–47 .

18.

Simon, R. I. (2001). Commentary: Treatment boundaries – flexible guidelines, not rigid standards . Journal of the American Academy of Psychiatry & the Law, 29(3), 287–289 .

19.

Summers, R. F. , & Barber, J. P. (2003). Therapeutic alliance as a measurable psychotherapy skill . Academic Psychiatry, 27(3), 160–165 .

20.

Tseng, W. S. , Matthews, D. , & Elwyn, T. S. (2004). Cultural competence in forensic mental health. New York: Brunner-Routledge .

Cross-cultural Boundary Dilemmas: A Graded-risk Assessment Approach

Abstract

Keywords

Get full access to this article

References