Setting and Maintaining Boundaries
Establishing and maintaining appropriate boundaries in the peer relationship is a complex issue. Boundaries are guidelines, rules or limits that dictate legal, reasonable, safe and permissible ways for one person to behave around another. Boundaries help us to define what is okay and not okay in any relationship. In the best and most healthy relationships, either personal or professional, boundaries are mutually negotiated early in the relationship.
It is essential that boundaries are clearly defined and consistently maintained. Relationship boundaries are established to:
- Promote trust.
- Increase safety.
- Demonstrate respect.
- Develop rapport (working alliance).
- Provide structure to helping relationships.
Maintaining clear boundaries is the responsibility of the peer support specialist, not the client. That is not to say that the peer support specialist is responsible if a client intentionally or unintentionally crosses a boundary. But it is the responsibility of the peer support specialist to recognize that there is a boundary issue, inform the client of the inappropriate behavior and identify appropriate solutions.
Many clients with behavioral health disorders have experienced boundary difficulties in their lives. Some of these boundary issues may have been a result of their disorder, while others may actually have contributed to or intensified the substance use or mental health problem. This is particularly true if the boundary violations have been in the form of physical, sexual or emotional abuse. That makes it all the more critical that appropriate boundaries are defined at the outset of the peer relationship rather than addressing boundaries when a problem arises.
Clear boundaries protect both the peer support specialist and the client. Some clients may find the discussion of boundaries uncomfortable and others may question the need for boundaries in a peer relationship. The peer support specialist should make the reason for boundaries clear to the client and get the client to agree to the boundaries that are set. It can be helpful if some of the boundaries are expressed in terms of the client’s rights to certain behaviors on the part of the peer support specialist. This makes it clear that the peer support specialist has the major responsibility for good boundaries in the relationship.
In a formal counseling relationship, the distinction between personal and professional relationships is very clear. In the peer support relationship, this distinction can be harder to make. Setting clear boundaries and being explicit from the start of the relationship is important. It may be hard to think about ways to establish boundaries while still feeling like a peer, rather than an authority figure. One way to address this is to present proposed boundaries and ask for the client’s agreement. Be open to adding boundaries that might make the client feel more comfortable, so long as the client’s proposals are consistent with agency policy and practice. Here are some things to consider about boundaries in your peer support relationships.
- To avoid a confusion between a friendship and a peer support relationship, keep the focus of your interaction with the client on the client’s needs. Discuss yourself only when disclosure provides mentoring or role-modeling related to the client’s situation.
- Consider wearing a badge when you are ‘on duty’, to clarify that you are available as a peer supporter only at specified times and places.
- Recognize your personal needs, and use a structured process such as supervision or debriefing with other peer supporters to avoid looking to the client to meet your needs or respond to your distress.
- Learn to recognize signs that indicate that you are overly-involved with the client or that the client is becoming too dependent and address the need to reduce the intensity of the relationship.
- Use of first names only and clear direction as to private and mobile phone numbers and home addresses.
Specific Boundary Issues for Peer Support Specialists
There are two types of disclosure boundaries that affect the peer support relationship. The first is the disclosure of information about the client. We refer to that boundary as “confidentiality.” As we discussed earlier in this module, clients have an absolute right to confidentiality. This right is so important that it is protected by law. In recent years the topic of boundaries has been extended to include “digital boundaries” such as e-mail and text contacts, tele-health, Google, and issues regarding online social networking between helping professionals and clients. Your agency policies and procedures should provide guidance to you about what the agency requires in terms of protecting client confidentiality.
The second boundary issue is self-disclosure by the peer support specialist. Your lived experience is an important part of your qualification to be a peer support specialist and you are expected to talk about your experience in a way that serves your client. That is, you should talk about yourself when it can provide either clarity or hope for your client, but should not talk about yourself if the purpose of the disclosure is not related to the client. Inappropriate self-disclosure can create confusion for your client. Here are some simple guidelines to using self-disclosure appropriately:
- Orient the client to the purpose of disclosure
- Disclose to inspire not vent
- Disclosure should be focused and selective to the client’s recovery goals
- Disclosure should not be too frequent
- Avoid the impression that the client has a responsibility to respond to disclosure
- Use disclosure differently with each client based on need.
Many of the ethical principles regarding boundaries focus on the issue of “dual relationships” or relationships outside of the helping role, such as developing a friendship with a client or engaging in business transactions with clients. Not all boundary crossings constitute dual relationships. Making a home visit, going on a hike, or attending a wedding with a client and many other ‘out-of-office’ experiences are boundary crossings which do not necessary constitute dual relationships. Similarly, exchanging gifts, hugging, or sharing a meal are also boundary crossings but not dual relationships.
Any relationship between the peer support specialist and the client that is not specifically focused on meeting recovery goals would be considered a dual relationship. Dual relationships may also involve family members of the client. Some examples of dual relationships would be:
- Landlord/tenant relationships regardless of whether the client is the landlord or the tenant
- Attending the same church as your client
- Having the client perform services (lawn care, child care, personal errands)
- Coaching a sports team on which a client or family member plays
- Borrowing or lending money.
Dual relationships can damage a peer support specialist’s ability to work with a peer objectively. Some types of dual relationships (such as romantic relationships) may be specifically addressed in a code of ethics. Other, more subtle boundary issues can create ethical dilemmas that are less obvious or are not as easily avoidable. That is why supervision is so important for peer support specialists. For the purposes of some ethical codes, it is acceptable to have a personal relationship with a former client at a specified time after terminating the helping relationship.
As persons in recovery, peer support specialists have much to offer in the addiction and mental health field. One area of concern that has been raised about using peer support specialists is that persons in recovery may be overly focused on recreating their own journey to recovery in their work with their clients. For instance, counselors who are strongly 12-Step oriented may reject other types of treatment approaches. In this circumstance, clients may also feel pressured to please the counselor by following their example on the road to recovery.
Peer support specialists who experience an increase in debilitating symptoms while at work should refer to the predetermined action plan they have shared with their supervisor and avoid interaction with the client until the symptoms subside.
The question of appropriate touch within helping relationships is strongly debated. Some codes of ethics may expressly forbid any type of touch, while others distinguish between intimate and non-intimate physical contact. It is important to recognize that many persons dealing with behavioral health disorders also have histories of trauma. For these clients, any type of touch within the helping relationship can create significant ethical dilemmas. Even something as simple as a hug can convey confusing messages to a client with a history of trauma.
Peer support specialists who have any type of physical contact with clients must have clear boundaries and an awareness that touch may complicate their peer relationship. The peer support specialist must clearly invite the client to discuss any discomfort that might be caused by unwanted touch and provide enough safety within the relationship that the client can raise this issue if necessary.
There is no vagueness about the issue of sexual involvement with a client. Sexual or romantic relationships between counselors and clients are always improper, even after the treatment has ended. The prohibition against this behavior is almost universally incorporated into codes of ethics. The peer support specialist has the primary responsibility of defining and maintaining this boundary. Sexual or romantic involvement with a client is a serious ethical violation with profound emotional repercussions for the client and serious professional repercussions for the peer support specialist.