Boundary Violations: A Culture-Bound Syndrome.
Journal of the American Academy of Psychiatry and the Law
29(3): 274-283, 2001.
A backlash against the self-actualizing psychotherapy movements of the 1960s
and 1970s in concert with recent concerns about professional sexual misconduct has led some
forensic psychiatrists to redefine many routine components of therapy as boundary behaviors. This
concern has been followed by the development of conservative guidelines for how therapists
should conduct themselves at the newly-defined boundary crossings so as to avoid "violations."
The slippery-slope argument that seemingly innocuous boundary crossings may lead inexorably to
professional sexual misconduct has lent an urgency and legitimacy to the guideline enterprise,
obscuring the perspective that the newly postulated boundaries do not represent the consensus of
practitioners in the field. Otherwise highly controversial claims about what is ethical and proper
behavior in psychotherapy gain a mantle of incontrovertibility when linked to predictions that
ignoring published boundary guidelines will result in damage to patient and litigation against
therapist. In this article, three widely advanced boundary guidelines are examined (therapist
neutrality, therapist anonymity, and stable fee policy) for coherence and relevance to the richly
diverse practice of psychotherapy.