Listen to this

practice

Where do we draw the lines?
Professional relationship boundaries and Child and Youth Care practitioners

Jennifer C. Davidson

Abstract: The question of professional relationship boundaries is a poignant one, in light of the many boundary grey-zones that are created by the variety of young people’s needs, practice settings, and professional relationship contexts within the field of Child and Youth Care. In order to support practitioners” development of critical thought and awareness of professional boundaries, this paper applies a professional relationship boundaries conceptual framework to Child and Youth Care work, and the literature is consulted to explore the impacts of boundary violations, influences on individual’s boundaries, cues to indicate blurring boundaries, and key strategies to maintain balanced boundaries.

Introduction
Professionals endeavor to maintain clear boundaries in their professional caring relationships with young people. As in most human services work, Child and Youth Care (CYC) practitioners strive to find a balance between (a) caring about the young people they work with in over-involved, dependence-creating ways, as they are genuinely moved by their life stories and current needs, and (b) not caring enough, as they defend themselves against burn-out, secondary traumatic stress, and compassion fatigue (Conrad and Perry, 1995; Figley, 2002). A variety of complex factors can tug at, and pull, professionals as they strive to define and maintain authentic, balanced connections in their relationships with the young people and families they serve.

These relational connections are guided by professional boundaries, which delineate how Child and Youth Care professionals express their care in the midst of challenging factors. These limit-lines between one’s self and another person (Alberta Association of Registered Nurses, 1998) can refer to elements such as one’s physical self, and to more elusive elements such as one’s social, emotional, psychological, or spiritual self. Professionals are responsible for setting and maintaining appropriate boundary limits with their clients, and the Child and Youth Care code of ethics promotes standards regarding this topic (International Leadership Coalition of Professional Child and Youth Care, 1995). However, in practice, identifying where some boundary lines are or where they ought to be drawn within a relationship can be very difficult due to their evasive nature and the myriad of factors that influence and define appropriate boundaries at any one time (Congress, 2001). Factors such as the needs of the young person, the role of the professional, the quality and depth of the relationship with the young person, the mandate of the agency, the physical construction of the setting, the size of the community, and the cultural context can work together to create boundary grey-zones which consist of circumstances in which simple, pre-prescribed answers do not easily apply (Heyward, 1993; Lazarus, 1994 and Sue, 1997 cited in Strom-Gottfried, 1999).

For example, consider a social boundary such as offering a young person one’s home telephone number. In most circumstances, agency mandates would forbid such a gesture for many important reasons (e.g., to preserve the practitioner from burn-out, to maintain the professional role of the practitioner in the young person's life, to ensure the young person finds various resources to meet his/her needs, and to protect the young person from exploitation). However, consider the difficulties in applying this social boundary for Child and Youth Care professionals who both reside and work within rural or minority communities (Gonsiorek, 1995; Anderson, 1999), or those who live with young people as house parents. Here, the agency standards intended to maintain professional boundaries do not fit the circumstances, and professionals are faced with finding unique ways of defining their relationship boundaries with the young people with whom they work as they aim to sustain a balanced, professional, caring relationship, and maintain their professional role, longevity, and effectiveness. Finding creative ways of identifying and clarifying one’s professional boundaries within these various relational and organizational contexts is a challenging task. Without specific knowledge and skills, crossing professional relationship boundaries unintentionally may be all too easy and may result in unhelpful interpersonal dynamics. Given the privileged and influential position Child and Youth Care practitioners hold it is critical that they be fully prepared to engage in the challenge of maintaining balanced boundaries.

This paper applies a conceptual framework for understanding relationship boundaries to Child and Youth Care practice, and cursorily examines the implications of boundary violations, influences on one’s professional boundaries, indicators of blurring boundaries, and key strategies to best maintain balanced boundaries as suggested by the literature. In this paper, the term client will respectfully be used to describe the young people and family members with whom Child and Youth Care practitioners engage in the course of their work. The term professional will refer to Child and Youth Care practitioners themselves, in recognition that the Child and Youth Care field is an established profession in North America. It is not the intention here to have the term professional imply a cold, distant relationship, but rather one that is informed by the values and skills that are unique to CYC.

Unique aspects of a professional Child and Youth Care role
Each of us participates in a variety of relationship roles throughout our lives “for example, that of a child, an employee, or a customer “and each role is delineated by its own unique boundaries. For example, what we share about ourselves with another person, our expectations of their behaviour toward us, and our use of personal space are determined by the boundaries of that relationship. It is the boundaries themselves that distinguish a professional relationship from other types of relationships, and these boundaries are particularly vital when the functions in the professional relationship resemble more familiar roles such as that of a friend, parent, or older sibling, as they can in Child and Youth Care work. Establishing and maintaining professional boundaries first requires an understanding of the distinctly unique role a Child and Youth Care professional plays in the life of young people and their families (Table 1).

Table 1

The professional relationship boundaries continuum
A basic conceptual framework, which provides both a point of reference and a common language for discussing the actions, choices, and processes related to the boundaries of human service providers” professional relationships, is provided in Diagram 1. This “Professional Relationship Boundaries Continuum” (Davidson, 2004) refers to professionals” attitudes toward emotional connections with, and involvement in the lives of, young people and their families in light of the position of trust and power that the professionals are privileged to hold. Relationship boundaries are placed on a continuum, with the extreme ends delineating the most significant boundary violations, those of being entangled at one extreme, and rigid at the other. The mid-range of the continuum represents the range of ideal balanced professional relationship boundaries, and the ground between balanced and either extreme reflects boundary breaches, indicating the degree to which a professional’s actions can be harmful to the client. Despite the limitations of being a linear model, this visual framework provides a starting point for a discussion of relational dynamics in Child and Youth Care practice.

Diagram 1

The professional relationship boundaries continuum

This continuum illustrates the range of professional relationship boundaries. The extreme ends of this continuum delineate the most significant and harmful boundary violations in the form of Entangled boundaries on one extreme and Rigid boundaries on the other. The midrange of the continuum represents the range of ideal Balanced professional boundaries (Davidson, 2004). The degree to which a professional’s actions are harmful to the client is indicated along the continuum by the terms breach and violation.

An individual who has an authentic and caring manner while maintaining clear boundaries is demonstrating balanced boundaries. These professionals remain aware of their position of power and take care neither to exploit a client’s vulnerabilities nor to infringe upon their rights. They actively use professional judgment, consistently apply self-reflection skills, and are intentionally accountable to other professionals. Professionals with balanced boundaries determine and attend to clients” unique and complex needs while maintaining the key distinctions of their professional role in the relationship.

Professionals with entangled professional boundaries are consistently over-involved in the lives of the clients they serve. They invest more of their time, emotional energy or favor in these relationships than in others, and they meet their own emotional, social, or physical needs through the relationship at the client’s expense.

In contrast, having rigid boundaries involves storming ahead with one’s own agenda inflexibly, condescendingly, and/or without attending to the unique and multi-faceted needs of the client. Professionals functioning with such boundaries lack authenticity and sensitivity and exploit the client’s vulnerabilities, abusing their position of power as they accentuate the power difference between them.

These descriptions reflect interactions occurring at the extreme ends of the continuum in order to illustrate the differences between the areas of the continuum. It is important to note that the underlying motivations of either extreme may or may not be well-intentioned, and that good intentions may neither counteract nor protect the other person from the impacts of blurred boundaries.

The continuum applied to Child and Youth Care practice
As suggested above, many factors play a role in defining what balanced boundaries are, for what is balanced in one context may be rigid or entangled in another. Consider, for example, professional boundaries related to touch. In a short-term residential facility for older adolescents, if a young person in their care reacts negatively to physical contact, staff members would be more likely to offer reassurance to them through verbal not physical means. Alternatively, a staff member caring for a scared young child newly placed in out-of-home care would be more likely to offer her or him a reassuring hug, preferably in the presence of another staff person. (For a helpful look at the use of safe, appropriate, and manageable touch in Child and Youth Care, see Ward, 1999.) In both these situations, staff members” responses are indeed balanced as they prioritize the young person's needs, and are driven neither by the practitioners” own needs nor by inflexible agency policy. However, reversing these responses would be less-than-balanced: that is, not hugging a young child who is in need of comfort may be demonstrating more rigid boundaries if this resistance stems from inflexibility and insensitivity to the child's needs. Conversely, a staff person who insists on hugging a young person despite their negative
response may be demonstrating a tendency toward entangling boundaries as it raises questions about whose needs are being met by this action. Clearly, the context, the individual’s needs, the professional’s role, and the potential for misinterpretations are important factors in defining what is balanced practice. Knowing both what behaviors are appropriate within each context and what personal needs might be driving one’s actions requires skills of critical thinking and self-reflection (Reamer, 2001a) as well as ongoing reflective consultation with team co-workers, agency code of conduct standards, and the Child and Youth Care Code of Ethics (International Leadership Coalition of Professional Child and Youth Care, 1995).

Impacts: Why is it important to maintain balanced professional boundaries?
Naturally, there are far-reaching implications to how professionals conduct themselves in their relationships with the clients they serve. Professionals who are balanced with their relationship boundaries provide room for individuals and families to grow and learn, while at the same time giving support and encouragement. Of course, there are considerable impacts on both clients and professionals of less-than-balanced practice as well. For example, professionals who have entangled boundaries may cause their clients to become increasingly dependent on them, stifling their self-determination. Those with rigid boundaries may be less effective at building rapport with clients, reduce clients” willingness to trust and selfdisclose, and perpetuate their feelings of low self-worth. As a result, these professionals are less likely to provide adequate help. In addition, professionals with less-than-balanced boundaries, whether tending toward being entangled or rigid, become less objective; they may make inaccurate assessments, choose less effective interventions, and impact their own experience by developing greater vulnerability to burn-out (Veith, 2001).

Influences: What influences professional relationship boundaries?
It is important to note that balanced boundaries are a professional ideal. By virtue of being human, however, professionals have some susceptibility to behaving outside of the ideal balanced range, depending on their situation. Understanding the influences that affect one’s boundaries, and the situations in which one is most vulnerable to crossing the boundaries of a client, is important for increased self-awareness and for avoiding boundary violations (Peterson, 1993; Bullis, 1995; Gonsiorek, 1995; Kowaz, 1996).

To explore these areas, professionals may wish to consider how their family, gender, culture, religion, and generation have influenced their boundaries. In addition, counter-transference can be a current influence that decreases one’s objectivity (Robbins, Chatterjee and Canda, 1998), which in turn can increase one’s vulnerability to crossing clients” boundaries. An on-going commitment to self-awareness can help professionals identify when counter-transference reactions may be occurring in their work. Questions to increase self-awareness may include, “With what types of clients and/or in what professional situations do I find myself becoming, to some degree, either entangled or rigid?”

Indicators: What cues can indicate increasingly blurred boundaries?
Extreme boundary violations, such as professional sexual misconduct, occur as part of a process, and are generally the result of incremental steps toward increasingly less balanced behaviors. The process itself crosses boundaries, since any transformation of a relationship that is intended to meet only a professional’s needs is exploitative and unethical long before sexual contact has occurred. Sex is simply one possible abusive outcome, remarkable because it is more detectable (Strasberger, Jorgenson and Sutherland, 1992; Fortune, 1995; Irons, 1995; Summer, 1995; Thompson, Shapiro, Nielsen and Petersen, 1995; Colton and Vanstone, 1996). To curtail increasingly blurred boundaries in their own and their co-workers” behaviors (Table 2), it is critical for professionals to be aware of these incremental steps, which lead to boundary violations.

Table 2

Strategies for maintaining balanced professional relationship boundaries
The human-services literature suggests several strategies for maintaining balanced professional boundaries. Key approaches include (1) ongoing consultation with others, and (2) intentional actions to take care of one’s self.

Synergy. The word synergy comes from the Greek work meaning “working together” (Oxford English Dictionary, 2002), and its meaning is embodied in the familiar saying “the whole is greater than the sum of its parts”. Research reflects that the more honest and open the communication between practitioners, the less likely clients” boundaries will be crossed (Thompson et al., 1995; Reamer, 2001b). Factors such as difficult emotional content, limited resources, full caseloads, clients” complex and intense needs, and relatively low societal recognition of the profession's value can make self-reflection within Child and Youth Care work difficult to maintain. Speaking with co-workers and appropriate experts on an on-going basis about the choices and dynamics within one’s professional relationships establishes the critical elements of accountability and perspective. It is in everyone’s best interest for professionals to ask others regularly both to give their perspective and to ask questions about their practice (Reamer, 2001a). The Child and Youth Care field in particular is in a good position to benefit, as Child and Youth Care work often takes place within team settings in which regular perspective check-ins can be implemented. A well-led team is an invaluable resource as it provides an arena of safety in which to reflect honestly on practice and relationships with clients. See Reamer (2001a) for a helpful seven-step ethical decision-making process (pp.107-113), applicable to situations of potentially blurring professional boundaries.

Self care. The literature indicates that professional boundaries are breached most often when a professional is feeling emotionally vulnerable (Irons, 1995; Vieth, 2001). A combination of personal vulnerabilities (for example, social isolation, depression, and lack of adequate support) and a stressful life event (for example, the end of a primary relationship) puts one in the greatest jeopardy of boundary crossing (Peterson, 1992; Bullis, 1995; Texas Medical Association, 2002). According to the International Leadership Coalition of Professional Child and Youth Care (1995), taking care of one’s emotional health is a Child and Youth Care professional’s ethical responsibility. Given that the professionals” emotional state impacts their boundary management capabilities, this task is of vital importance in Child and Youth Care work. Many professionals have developed habits to take care of themselves during particularly stressful life episodes, which can play an important role in the maintenance of balanced boundaries. Recommendations compiled from the literature are provided in Table 3.

Table 3

Conclusion
The difficult and complex boundary grey-zones in Child and Youth Care work require that practitioners develop critical thinking skills, awareness of professional boundaries, and effective approaches to prevent boundary breaches in order to provide the best possible care to young people and their families. In this paper, a professional relationship boundaries conceptual framework is applied to Child and Youth Care work, and the impacts of boundary violations, the factors influencing an individual’s boundary development, the cues to indicate blurring boundaries, and the key maintenance strategies for balanced boundaries are explored in the hopes that this information, though cursory, may contribute to the important dialogue of relationship boundaries in the Child and Youth Care field.

References

Alberta Association of Registered Nurses (1998). Professional boundaries for registered nurses: Guidelines for the nurse-client relationship. Edmonton, AB, Canada: Author.

Anderson, D. (1999). Sexual abuse, professional boundaries and the rural world. Journal of child Sexual Abuse, 8, 3. pp. 85-93.

Colton, M. and Vanstone, M. (1996). Betrayal of trust: Sexual abuse by men who work with children. London: Free Association Books.

Conrad, D. and Perry B. (1995). The cost of caring: Understanding” and preventing secondary traumatic stress when working with traumatized and maltreated children. Child Trauma Academy. Retrieved 31 July, 2003, fromhtlp://wwwchildtrauma.org/ctamaterials/Cost of Caring Lasp.

Davidson, J.C. (2000). Knowing where to draw the lines: Professional boundaries with clients. [Training manuscript]. Protective Services Training Institute of Texas, University of Houston.

Davidson, J.C. (2004). Professional relationship boundaries: A social work teaching module. Social Work Education. Forthcoming.

Figley C. (2002). Compassion fatigue: Psychotherapist’s chronic lack of self care. Psychotherapy in Practice, 58, 11. pp. 1433-1441.

Fortune, M. (1995). Is nothing sacred? When sex invades the pastoral relationship. In J.C. Gonsiorek (Ed). Breach of trust: Sexual exploitation by health care professionals and clergy. New York: Sage Publications.

Gonsiorek, J.C. (1995). Boundary challenges when both are gay males. In J.C. Gonsiorek (Ed.), Breach of trust: Sexual exploitation by health care professionals and clergy. New York: Sage Publications.

Heyward, C. (1993). When boundaries betray us: Beyond illusions of what is ethical in therapy and in life. New York: Harper-Collins.

International Leadership Coalition of Professional Child and Youth Care (1995). Code of ethics: Standards for practice of North American Child and Youth Care professionals. Retrieved 31 July, 2003, from http: / /www pitt.edu / -mattgly / CYCethics.html

Irons, R. (1995). Inpatient assessment of the sexually exploitative professional. In J.C. Gonsiorek (Ed.). Breach of trust: Sexual exploitation by health care professionals and clergy. New York: Sage Publications.

Kowaz, A. (1996). Knowing where the lines are. [Unpublished manuscript]. Vancouver, B.C., Canada: British Columbia Institute on Family Violence.

Peterson, M.R., (1992). At personal risk: Boundary violations in professional client relationships. USA: W.W. Norton & Company.

Reamer, F.G. (2001a). Ethics education in social work. Alexandria, VA: Council on Social Work Education.

Reamer, F.G. (2001b). Tangled relationships: Managing boundary issues in the human services. New York: Columbia University Press.

Robbins, S., Chatterjee, P. and Canda, E. (1998). Contemporary human behavior theory: A critical perspective for social work. USA: Allyn and Bacon.

Strasberger, L.H., Jorgenson, L. andSutherland, P (1992). The prevention of psychotherapist misconduct: Avoiding the slippery slope. American Journal of Psychotherapy, 46, 4. pp. 544-555.

Strom-Gottfried, K. (1999). Professional boundaries: An analysis of violations by social workers. Families in Society, 80, 5. pp. 439-449.

Summer, G.L. (1995). Education in preventing sexual misconduct in Alabama. Alabama Medicine, 64, 12. p. 5.

Sykes, J. B. (Ed.). (2002). Oxford English Dictionary. Oxford: Oxford University Press.

Texas Medical Association. (2002). Maintaining professional boundaries [online], Committee on Physician Health and Rehabilitation, Continuing Medical Education. Retrieved 31 July, 2003 from http: / / www. texmed.org / cme /phn / mp_p.

Thompson, P, Shapiro, M., Nielsen, L. and Peterson, M. (1995). Supervision strategies to prevent sexual abuse by therapists and counsellors. In B. Sanderson (Ed.), It’s never OK: A handbook for professionals on sexual exploitation by counselors and therapists. Minneapolis: Minnesota Department of Corrections.

Vieth, V (2001). When days are grey: Avoiding burnout as child abuse professionals. National Center for Prosecution of Child Abuse Update, 14, 4.

Ward, A. (1999). “Residential staff should not touch children”: Can we really look after children this way? In A. Hardwick and J. Woodhead (Eds.), Loving, hating and survival: A handbook for all who work with troubled children and young people. London: Ashgate.

This feature: Davidson, J.C. (2004). Where do we draw the lines?: Professional relationship boundaries and Child and Youth Care practitioners. Journal of Child and Youth Care Work, 19. pp. 31-42.