Professional Boundaries in Nontraditional Settings.

Abstract

Summary Home-based services may be the only way for some patients toreceive services because of transportation limitations, mobilityissues, or cultural barriers to office-based treatment. In addition,for some clients, home-based services may be clinically indicated.For example, multisystemic therapy, which occurs largely in thenatural environment of the child, has been an effective treatmentthat can often be used in lieu of hospitalizations or institutionalplacements (Henggeler et al., 2002).Delivering services in nontraditional settings has the potential tobenefit clients. However, services in these settings can also lead tochallenges to helpful therapeutic boundaries. When working in thehomes or residences of clients, we recommend that psychologistsemphasize informed consent, especially about therapeuticboundaries.Whenever possible, the impact of boundary crossings on therapyand the therapeutic relationship should be considered ahead oftime. Effective psychologists balance social amenities that maystrengthen the therapeutic relationship with the need to focus ontreatment goals (Andersen et al., 2001; Knapp & Slattery, 2001).Preparing to handle possible boundary crossings can lead to suc-cessful decision making under difficult situations.Supervisors can minimize problems by training and monitoringsupervisees who work in the residences or homes of clients.Training should emphasize the general rule that some boundariesshould be kept firm, especially when workers feel threatened or