The Professional and Boundary Issues

by Nancy Ellett Allison, Ph.D

Dr. Allison works for the Baptist General Convention of Texas and was formerly the Chaplain Coordinator for Women and Children’s Services in the Department of Pastoral Care and Counseling at the Baylor University Medical Center in Dallas, Texas.

This article has been reproduced with permission from Christian Ethics Today. Copyright © February 1997.


Four years on the mission field was all it took to lose touch with the jargon and music of the day. When we left Dallas in 1987 the only boundaries I would consider relevant were those of the fence between my yard and my neighbor’s. By the time I stepped back into the clinical world of a hospital everyone was discussing the need to set clear boundaries and loved Bobby McFerrin’s musical instructions: “Don’t Worry, Be Happy.” It took awhile, but I finally heard the tune myself and found a way to understand relationship boundaries and was quite grateful to discover that boundary-setting hadn’t been a problem for me in years.

… Do you know if you are susceptible to a boundary violation in your professional relationships?

Boundaries are the limits that allow for safe connections between individuals. A boundary is that defining space which clarifies “you” and “me.” Our understandings of what are acceptable boundaries grow out of our family of origin. A healthy boundary allows an individual to relate with genuineness to others. Persons with healthy boundaries know how to provide for their own personal privacy and safety (and by extension, that of their young children). Appropriate intimacy and the achievement of trust is possible in relationships because there is no fear of losing “self” in establishing connections with others.

Persons with unclear boundaries establish the “locus of control” outside themselves. They allow others to define who they are, what they think, where they go. Intimacy for this individual can easily lead to abuse if those with whom they relate prove untrustworthy. These persons often find their way to the pastor or chaplain’s office and frequently “thrive” under the leadership of an authoritarian minister. Persons with rigid boundaries are generally distant, unconnected, and lonely. These individuals have found “safety” through rejecting connections with others. Frequently these responses are a result of past abuse or emotional trauma. Intimacy and trust seem beyond reach. For these loners, a small church might be too threatening, but a large congregation may be the place where their anonymity is protected.

Our boundaries vary depending upon our roles. With two young daughters in our household, it is my responsibility to continue to help give form to their unclear boundaries and help them know who they are: gifted girls created in God’s image. With ministerial colleagues and friends from church and PTA my boundaries bounce around depending on my needs and the others capacity to meet those needs.

However, when I am ministering in a professional role, my responsibility to set the limits is absolute.

The professional role is held by anyone claiming to have special expertise about a particular body of knowledge. Physical therapists, mechanics, lawyers, secretaries, chaplains, administrators, teachers, plumbers, and pastors are all professionals. In a professional role, the professional makes an ethical covenant with society to exercise self-restraint, to give and not take from the parishioner/patient/client/student, and to monitor self-interests. Obviously these covenants are violated daily. Nevertheless, our society continues to uphold these implicit standards, especially in a court of law when a client has somehow been abused by a professional. The professional is considered the person of power in the relationship.

There are variable sources which create professional power. A primary source is the individual’s sense of personal power. A young woman or man who has not yet cut the financial ties to Mom and Dad and is still searching for the “right” residency, may not be the most imposing doctor in the hospital. Nevertheless, in the physician/patient relationship it remains this resident’s responsibility to structure the relationship. A professor who has been teaching for decades, with pages of publications as credits, and an equally expansive ego may easily intimidate the incoming first year students. This professor’s personal power is well established. How it is used professionally will be a marker for setting or violating boundaries.

A second source of professional power comes from the societal ascription given to the position an individual occupies. On the church staff hierarchy youth and children’s ministers are not seen as positions of power. In some churches they are excluded from deacon’s meetings. A young person in either of these roles can be easily intimidated by imposing committee members and parents who would not consider bullying the pastor. However, the youth minister’s responsibility to set limits with the parents and with the youth remains a key learning element for this maturing professional.

Professional power is also enhanced through the accumulation of expert knowledge. A physical therapist may not consider herself a powerful individual, but when she is the one who knows the most on the health care team about exercising a certain set of muscles, she speaks from a position of power when that becomes an issue. Likewise, if the physician has been telling a patient that cooperation with the physicial therapist will have a major impact on his or her recovery, the patient’s expectations and projections will influence the amount of professional power the physical therapist holds in the relationship. This final variable is often the source of much abuse, sexual, emotional, or psychological.

In order to establish a helping relationship the individual in need must relinquish some level of control to create trust. The client or patient’s trust rests on the assumption that the professional will operate within the context of the client’s need. When the client expects this and projects an aura of sanctity onto the professional, the client’s vulnerability becomes a key factor in the relationship. This is the reason that a client (adult or teen, male or female) is not considered morally and legally culpable if an illicit relationship develops between the two. It remains incumbent upon the professional to set the limits of the relationship.

Other sources of a client’s vulnerability include how great the need is, how immediate the need for resolution of the problem may be, and the client’s dependency on the professional for help in resolving the problem. An immigrant woman fleeing an abusive husband in a strange city is an incredibly vulnerable individual.

Boundary violation is more a process rather than a single event. Few professionals “decide” to take advantage of an individual. Yet when professionals deny or remain unaware of their personal significance, power, or authority they will begin the process of boundary violation by misusing that power. And any time a professional exploits a relationship to meet personal needs rather than the needs of the client, the boundaries have slipped and the professional is in peril.

The key to dealing with these issues?

Know who you are; know your gifts and strengths; and commit to use those strengths (power) in service to others. Find ways of having your personal needs for intimacy met appropriately. No spouse or best friend can meet all your needs but perhaps a cluster of persons with whom you share a reciprocal relationship cna. No one seeking your help in a professional role should be meeting your needs for receiving care.

And if you do all this, you can sing with confidence McFerrin’s refrain, “Don’t Worry, Be Happy” for your relationships will be clean and your boundaries healthy!

Sources

Peterson, Marilyn R., At Personal Risk: Boundary Violations in Professional-Client Relationships. (New York: W.W. Norton Company, 1992)

Snow, Candace and David Willard, “I’m Dying to Take Care of You… Nurses and Codependence: Breaking the Cycles” (Redmond, WA: Professional Counselor Books, 1989)


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