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Negotiating boundaries can be particularly challenging for recovering professionals

May 1, 2013
by Shannon Brys, Associate Editor
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The most common cause for disciplinary action among practicing professionals and academics is the lack of professional behavior. According to experts in workplace dynamics, professionals must take care to recognize internal guides of character while external guides, such as laws, policies and ethical codes of the practice, must also be followed.

For the past ten years of his career, Philip Hemphill, PhD, LCSW, program director of the professional enhancement program at Pine Grove Behavioral Health in Mississippi, has spent much time and effort helping professionals to develop a better self-awareness and be able to understand how to navigate the different expectations that professionals have.

Hemphill, who will be presenting on the topic of professional boundaries and ethics in September at the National Conference on Addiction Disorders (NCAD) in Anaheim, notes the high levels of stress in behavioral healthcare organizations today. He says within the context of cultural changes that are occurring in society, new technology that is impacting the profession, anxiety created by the ambiguity of issues related to the Affordable Care Act (ACA) and all the stressors that are going into implementing the changes required for reimbursement, professionals have an increased responsibility not only to have personal and professional self-awareness, but also to be aware of what’s happening in the world around them.

Recognizing vulnerability

Even amongst the stress, Hemphill comments that it’s important to understand and be aware of one’s vulnerability, and be able to recognize if a person is in life crisis, going through a life transition, or is lonely. Another important aspect to assess is a person’s relationship patterns because relationships are usually the tool used in meeting needs, he explains.

Additionally, recognizing that there are certain patients who increase the probability of having boundaries problems is crucial. These patients are more dependent, rely more on advancement in the relationships, and have a history of trauma, shame and self-blame. Professionals are expected to have an increased awareness of these specific indicators, he says.

The main thing to remember, according to Hemphill, is that there’s no expectation that the patient has to set the boundaries; it’s expected and clear that the professional has to set them.

Setting boundaries

Although many boundaries are black and white, Hemphill notes that a good portion of them are gray and context-dependent, and his discussion at NCAD titled, “Boundaries and Ethics: I don’t want to talk about it,” will explain how to navigate the complexity of these boundaries. He also plans to share how to increase self-awareness in the context of being able to provide high-quality care. Because providing care is now under scrutiny, being rated, and tied into reimbursement, the stress level of professionals has increased and this creates an additional obstacle for them to be mindful of their boundaries.

Some of the specific boundary lines he’ll cover will relate to how to manage time, gift-giving, different roles that professionals are expected to maintain, and payments. Also, he says it’s important to not look at a specific client as “special,” because that begins to set up problems with boundaries.

The treatment profession requires vast amounts of self-discipline and self-reflection, and ultimately, being able to deal with some problems on one’s own, Hemphill says. Because many people go down this path, they are less likely to consult with other people.

“A strong message I want to really convey is the importance of taking care of yourself and reaching out to others if there’s any possibility that there’s problems going on,” he explains.

Ethics and boundaries scenarios

The biggest challenge for professionals who are in recovery themselves is learning how much is appropriate to self-disclose. When professionals see a patient or client at a meeting, how much can they self-disclose? When is it destructive or unethical to self-disclose?

If a patient shared new information at a meeting at which the professional is present, what can/should the professional do with that information? These issues can arise in various roles outside of the treatment center  including: attending the same AA meetings, living in the same community, being a fellow parent, being a  fellow board member, or just simply seeing someone out in public.

The fact that there’s a fiduciary relationship seems to help maintain professionalism and follow the expected ethical guidelines.

“There’s a power imbalance and a knowledge imbalance — you get to know a lot about the person but they don’t really get to know much about you. Issues regarding confidentiality and documentation cannot be compromised as this can destroy the therapeutic relationship. Information obtained in public should be openly reviewed in a timely manner to reinforce an open, honest, and trustworthy relationship,” Hemphill explains. 

Recovering professionals

In his daily experiences working with recovering professionals, the main issue he has noticed is people having a hard time managing life stressors and not being prepared for the interpersonal skills that are required to have a professional career. While the newly recovered professionals are adjusting and adapting, some of them have an inability to manage their authority or have a difficult time with other people in the organization.