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Establishing Therapeutic Boundaries with Patients

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In the field of mental and behavioral health, boundaries are essential. Professionals work closely with individuals on deeply emotional and challenging topics to help them address things like mental health conditions, trauma, coping skills, and more. They utilize interventions that help patients navigate their experiences and improve their own mental health.

The relationship between therapists and their patients is intricate and complicated. Without healthy boundaries, unhealthy dynamics can be introduced that do not help the patient in the long term. Learning how to set healthy boundaries is integral to making sure your patients are well taken care of and that you are approaching the relationship responsibly as their provider.

The Importance of Healthy Boundaries in a Therapeutic Relationship

Boundaries within the therapeutic relationship help protect your client. They are established during your first session and set the tone moving forward. These boundaries are vital in preventing any additional emotional trauma to your patient. The purpose of therapy is to improve your patient’s emotional wellbeing, not worsen it.

Poor boundaries do not just harm the patient, but they can have a bad impact on the provider as well. Taking on too many of the patient’s emotions, or relating them too close to your own life can quickly lead to emotional burnout as a professional.

Examples of Boundary Violation in Therapy:

  • Competence – A boundary of competence in therapy is when a professional only offers services on topics/specialties in which they are fully competent. For example, a provider that specializes in addiction counseling should not offer marriage counseling services. Instead, they should refer their client to the right specialist.
  • Dual-Relationships – Therapeutic relationships should never exist alongside other relationship types. A dual relationship is when a provider has a relationship with a client outside of the therapeutic setting. For example, a therapist should not offer services to a friend or family member.
  • Location – Therapy should take place in a secure and professional setting and cannot take place in general places. For example, a therapist should offer services online via a secure telehealth portal or in an office setting. They should not offer services to patients in a coffee shop or busy location where security is an issue.
  • Self-Disclosure – Providers should refrain from disclosing personal information about themselves to the patient. This is an easy boundary to cross for professionals that want to make their clients feel safe and empathized with, but it can start to make the patient view you more as a friend than their provider.
  • Non-Sexual Physical Contact – Physical contact of any sort can send the wrong message to clients about the status of the therapeutic relationship, and make them feel uncomfortable, or unsafe. While a hug goodbye or a hand on their shoulder might seem like the right thing to do after an emotional discussion, it is not appropriate in the therapeutic setting.
  • Sexual Misconduct – Sexual relationships of any sort are a huge boundary and ethical violation that providers should never cross. There is a power imbalance between patients and their providers and this kind of relationship can disrupt a patient’s view of people who are supposed to be safe individuals in their life.
  • And More – There are many ethical boundaries that therapists need to account for during the therapeutic relationship to make sure their patients are protected and that they create a safe setting.

7 Tips on How to Set Healthy Boundaries in Therapy

Now that we know the dangers of a therapist crossing boundaries with their patient, there are steps providers can take to establish healthy boundaries.

  1. Contracts – Contracts can be an effective way to communicate to the patient the dynamic that will exist between you and them. In it, you can educate patients about important therapeutic boundaries and why they are there for their protection. These contracts can establish boundaries like location, areas of competence, and more to make sure the patient is aware.
  2. Stay Self-Aware – With so many emotions in this profession, it can be easy to cross less noticeable boundaries like self-disclosure or to feel like a friendship is forming. It is important to stay self-aware so that you can identify when patterns are forming or so you can pinpoint your own emotions and make smart decisions on how to move forward.
  3. Beware of Physical Touch – Remember that any form of physical touch is a big no in this setting. Even if you feel like the patient would not receive it the wrong way, it is still a boundary that should not be crossed.
  4. Refuse Gifts – If patients give you gifts, do not take them. With your patient viewing you as a safe and trusted person, they might try to bring your gifts to show their appreciation. Kindly refuse the gifts and let them know that you appreciate the gesture.
  5. Limit Contact – Only communicate with clients via appropriate outlets. This means that you should exclusively communicate with them during sessions when scheduling, or via their patient portal. Do not give out your phone number.
  6. Refer Out – If you feel like the therapeutic relationship is at risk, it is best to refer out before a boundary is crossed. While this may sound difficult, it is in the patient’s best interest to start with a provider where that relationship is protected.
  7. Communicate to Other Professionals – If you have questions on how to make sure you are setting healthy boundaries, talk to those who work in your field. You may find that other providers have experienced the same kinds of situations and they might have helpful advice.


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