Boundary Issues for Traumatologists

An ethical dilemma is a situation in which an individual cannot meet obligations to two different parties simultaneously (e.g., client/organization, self/client) without violating an ethical commitment to one or the other. As David Hardcastle and others have noted, ethical dilemmas occur when ethical guidelines do not give clear directions or indicate clearly which ethical imperative to follow. Dilemmas are often linked to specific sought-after outcomes and goals. Frank Loewenberg and Ralph Dolgoff suggest that ethical dilemmas need to be resolved by considering which decision produces the greatest good for the greatest number of persons, organizations, groups, families, or others. Trauma practitioners face many situations that have potential ethical principles embedded within them, including issues involving boundaries.

When faced with an ethical dilemma of any nature, it is important to determine

• who is the client,
• the knowledge base that guided chosen actions, and
• the values that guided actions and seemed to apply to the particular situations.

These three determinations can help resolve a dilemma. Also, following the basic principles of ethical practice can help in that resolution. Five that are most important are those of

• acting to benefit others,
• seeking to promote justice,
• respecting client autonomy,
• being faithful to the client (versus the agency, perhaps?), and
• doing no harm.

As noted above, one major ethical dilemma resolves around the issue of boundaries. A boundary is a limit and may be geographical (spatial), legal, or personal in nature. Boundaries can be protective and aim to foster maintenance of safety without exploiting or causing harm. In many instances, traumatized persons who seek counseling or other forms of assistance have had their personal boundaries violated in some way whether from abuse, torture, identity theft, violence, or other events. It is often difficult to ask for help. If practitioners maintain personal and professional integrity as well as authenticity and congruence between beliefs and actions, boundary violations will occur less frequently.

Trauma practitioners set boundaries concerning

• with whom they are able or unable to work,
• their availability to work and be on call,
• their tolerance for self-destructive behaviors,
• their policies toward sharing personal material (self-disclosure) and feelings,
• the use of and balance between collaboration and power,
• the names by which they are called (Dr., first, last, any),
• policies toward collection of fees,
• social relationships with clients when contact is unavoidable (e.g., small town or rural community),
• language used,
• role and use of touch (handshakes, hugs),
• continued contact after termination of professional relationships,
• gift giving and receiving, and
• use of personal and environmental space.

According to Richard Epstein and Marilyn Peterson, in two separate publications, boundaries are the limits that allow for a safe connection between individuals and are based on the needs of the individual being served or helped. When these limits are altered, any aspect of what is allowed in the therapeutic relationship may become ambiguous. Such ambiguity is often experienced as an intrusion into the sphere of safety of the person being helped (e.g., the client in whatever setting). Pain from a violation of boundaries may come as a delayed reaction, and the violation itself may not even be recognized or felt until later when harmful consequences emerge or become evident.

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