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Keeping Boundaries is an across-the-board review of the subject of boundary maintenance in psychotherapy. Using a comprehensive approach, this book examines the problem of therapeutic boundaries and boundary violations from multiple viewpoints, including historical antecedents, sociological mechanisms, object relations theory, psychodynamic theory, practical technique, and the mental health and training of psychotherapists. It covers a variety of boundary issues, including dual relationships, informed consent, fees, gifts from patients, maintaining confidentiality, avoiding abuse of power, and helping therapists to protect themselves against exploitive patients.
Written in a clear and jargon-free style, this book provides the therapist with practical clinical advice supported by extensive references and clinical vingnettes.
For mental health professionals in need of a comprehensive, accessible, erudite guidebook on boundary issues, this book is highly recommended. For professionals involved in teaching about boundary issues, it is an excellent source that covers the most salient and important points. Reading Keeping Boundaries will enhance clinical understanding and ethical behavior for mental health professionals in particular and professionals in general.
— Psychiatric Services
Richard S. Epstein, M.D., is a psychiatrist in private practice in Bethesda, Maryland. He is President-Elect of the Washington Psychiatric Society, Clinical Professor in the Department of Psychiatry at Georgetown University School of Medicine, Washington, DC, and Clinical Associate Professor in the Department of Psychiatry at the Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, Maryland.
General Aspects of Therapeutic Boundaries and Boundary Violations. The nature and function of therapeutic boundaries. Ego boundary development and its relationship to the therapeutic frame. Factors common to all boundary violations. Specific Boundary Issues. Introduction to section II. Stability: Creating an atmosphere of trust and reliability. Whom should a psychotherapist treat? Problems of patient selection when a dual relationship exists. Respecting the patient's autonomy: maintaining a position of neutrality. Balancing the therapist's financial needs against those of the patient: monetary compensation in psychotherapy. Confidentiality. Maintaining anonymity. Abstinence and the management of erotic feelings in psychotherapy. Treating the patient who tries to exploit the therapist. Issues Concerning the Mental Health and Training of Psychotherapists. Psychological characteristics of therapists who commit serious boundary violations. Education and self-assessment: how can therapists learn to improve their boundary skills? Appendix. References. Index.