Boundaries in Psychotherapy

    Ethical and Clinical Explorations

By Ofer Zur, Ph.D

Published by American Psychological Association, APA Books 2007

Table of Contents

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This most comprehensive book on ethical therapeutic boundaries covers the following topics:

Non-Sexual Touch . . . Therapist’s Self-Disclosure
Gifts from Clients and Therapists
Dual Relationships: Social, Professional & Business; Sequential & Concurrent; Avoidable, Unavoidable & Mandatory
Bartering . . . Home Visits . . . Fees . . . TeleMental Health – E-Therapy
Adventure Therapy . . . Attending Clients’ Weddings
Leaving the Office with a Phobic Client. . . Incidental or Chance Encounters
Clothing . . . Language . . . Silence
and much more . . .

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Advance Praise:

“Dr. Zur is a bold, effective and intellectually incisive psychotherapist who has delineated appropriate interventions that balance patient need with the finest in ethical conduct. These accord the patient treatment that would otherwise be denied. He has done for the Code of ethics what James Madison did for our Bill of Rights.”

Nicholas A. Cummings, Ph.D., Sc.D., Distinguished Professor, University of Nevada, Reno; President, Cummings Foundation for Behavioral Health; Former President, American Psychological Association.

“This book provides refreshing coverage of one of the most controversial issues in psychotherapy-the subject of psychotherapeutic boundaries. Gone are the blanket rules of avoiding all boundary crossings regardless of client needs, therapeutic settings, and therapist skills. Ofer Zur, a strong proponent of a rational approach, encourages readers to apply a decision-making model that lends itself to careful and creative problem solving with clients.”

Leon VandeCreek, Ph.D., Professor, School of Professional Psychology, Wright State University, Dayton, OH; Fellow, American Psychological Association

“Dr. Zur’s valuable contribution places the ethical proscriptions in today’s psychotherapy in a historical context and challenges readers to demonstrate that those proscriptions remain valid. His discussion of boundaries, ethics, and risk management will stimulate independent thinking rather than passive allegiance to the perceived status quo. Dr. Zur advocates exploring and analyzing potential boundary crossings while carefully weighing the costs and benefits for the patient and the treatment. This book will stimulate a great deal of thought and discussion among psychotherapists.”

Martin H. Williams, Ph.D., Clinical and Forensic Psychologist, San Jose, CA



  • Boundary Crossing Versus Boundary Violation
  • Two Types of Boundaries for Psychotherapy
  • Crossing Boundaries While Meeting the Standard of Care
  • Crossing Boundaries While Managing Risk
  • Boundary Shifts in the History of Psychotherapy
  • Boundaries and the Codes of Ethics
  • Map of the Book

Part I: Boundaries in Context

Chapter 2. Reflections on Power, Exploitation, and Transference in Therapy

  • Power and Boundaries
  • Slippery Slope Boundaries
  • Transference and Boundaries

Chapter 3. Contexts of Therapy

  • Client Factors
  • Therapeutic Setting
  • Setting Factor
  • Therapist Factors

Chapter 4. A Decision-Making Process for Boundary Crossing and Dual Relationship

  • Ethical Decision Making
  • Ethical Decision Making Regarding Boundary Crossings and Dual Relationships
  • Risk–Benefit Analysis of Action and Inaction
  • A Decision-Making Process

Part II: Boundaries Around the Therapeutic Encounter

Chapter 5. Time and Money: Managing Time, Fees, Billing, and Bartering

  • Time
  • Fees, Billing, and Other Money Concerns
  • Bartering
  • Case Study: Cursed by Money

Chapter 6. Space for Therapy

  • Home Visits
  • Outdoor or Adventure Therapy
  • Clinical Interventions Not Possible in the Office
  • Ceremonies, Rituals, and Life Transitions
  • Giving or Getting a Ride
  • Incidental Encounters
  • Context of Therapy
  • Confidentiality and Other Considerations in Alternative Therapy Settings
  • Ethics, Standard of Care, CPT, and Risk Management Considerations
  • Case Study: Hospitality With Strings Attached

Chapter 7: Home Office Practice

  • Therapist’s Self-Disclosure
  • Managing Time, Place, and People
  • Safety, Privacy, and Confidentiality
  • Client Factors
  • Screening and Informed Consent
  • Ethical Considerations
  • Home Office and Context of Therapy
  • Case Study: A Challenging Setting

Chapter 8: Technology for Delivering Care

  • TeleMental Health and Therapeutic Boundaries
  • Ways That TeleMental Health Works
  • Clinical, Ethical, and Legal Considerations
  • Guidelines for Using Technology in Psychotherapy
  • Case Study: The Medium Is Not the Message

Part III: Boundaries Within the Therapeutic Encounter

Chapter 9: Self-Disclosure

  • Self-Disclosure as an Ethical and Boundary Issue
  • Therapist’s Choices in Self-Disclosure
  • The Evolution of Societal and Therapeutic Attitudes Towards Self-Disclosure
  • What the Therapy Setting Discloses
  • Client Considerations
  • Theoretical Orientations
  • Self-Disclosure and Therapeutic Alliance
  • Case Study: Too Much Information

Chapter 10: Touch

  • Touch as an Ethical and Boundary Issue
  • Ethics and Standard of Care Considerations
  • Types of Touch in Therapy
  • Scientific and Cultural Views on Touch
  • Touch in Context
  • Case Study: A Touchy Subject

Chapter 11: Gifts

  • The Meaning of Clients’ Gifts
  • How Setting Affects the Meaning of Gifts
  • Gifts by a Third Party and Medication Samples
  • Timing and Therapeutic Orientation
  • Therapists’ Gifts
  • Ethics and Keeping Records of Gift-Giving
  • Therapists’ Responses to Clients’ Gifts
  • Case Study: A Blessing in Disguise

Chapter 12: Personal Space, Language, Silence, Clothing, Food, Lending, and Other Boundary Considerations

  • Space Between Therapists and Clients
  • Spoken Language
  • Silence
  • Clothing
  • Sharing Food With Clients
  • Lending and Borrowing
  • Greeting and Sympathy Cards Case Study: From Cupcake to Sculpture-Many Ways to Communicate

Part IV: Final Thoughts

Toward a Better Understanding of Boundaries in Therapy

Appendix A: Examples of Boundary Crossings and Boundary Violations in Psychotherapy
Appendix B: Ethics Codes on Boundaries and Dual Relationships in Psychotherapy and Counseling
About the Author

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