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Professional Boundaries are the limits to the relationship between someone in a professional role and the person in their care, the borders that mark the edges between a professional relationship and a personal relationship. They are like the riverbanks to the river, allowing work to take place, in a defined space.

In the literature on Professional Boundaries there are several attempts at defining boundaries. Our favoured definition is by author Marilyn Peterson, who defines them as ‘The limits that allow for a safe connection based on the client’s needs’.

Professional Boundaries serve to protect the integrity of the professional relationship and are intended to keep people safe from harm.

The Oxford English Dictionary says that a boundary is ‘That which serves to indicate the limits of anything’ and ‘The limit itself.’

In medicine the Hippocratic Oath (3rd – 5th Centuries BC) says “Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males”. Further back the code of the Nigerian healing arts (Brodsky, 1989) also proscribed sexual contact with patients.

Boundaries are there to keep people safe. They do not negate a recognition that everyone has equal value as citizens. They note that the professional relationship is inherently imbalanced; that what people seeking help need is for professionals to do what they are there to do, and to behave with integrity. No-one is better than anyone else, and one party has additional power, conferred by the role. This power carries the responsibility to use it well.

The power differential exists whether or not we feel it or believe it.

The literature defines boundary crossings as happening when the normal boundaries are crossed in some way, which may be beneficial to the client. Boundary Violations are defined as always being harmful, or having the potential to cause harm(Gabbard & Myers 2008).

There is some evidence to suggest that this is possible for some practitioners (Coe & Gabbard 2012). Gabbard and others in the USA have shown that rehabilitation is possible; the key issue is in the identification of contextual and risk factors, and the development of rehabilitation plans which are directly connected to these. The GMC will always take action on improper relationships, and will be informed in its decision-making by the remedial action taken, the level of insight and the specific circumstances of the transgression. Openness and honesty following a transgression are key.

Although there have been a number of cases where multiple offences have been committed these cases are relatively uncommon. Most boundary violations are one-off transgressions and assessment and rehabilitation specialists report that people at all stages of their careers violate boundaries. and that there are higher rates for people who are further ahead in their professional careers (Coe 2012). The majority of transgressions seem to be committed by people who themselves experience personal and professional stress, sometimes with additional trauma (Swiggert et al). They also report that there are more reported cases of male practitioners violating boundaries then female.

In summary, one is marked by informality and the other is characterised by the existence of rules, regulation and defined boundaries. People who get into trouble around boundaries have often confused their personal life with their professional life.

Violations of boundaries can lead to a need for long-term psychological help for the people affected, who may be affected due to: failure to have the problems for which help was sought dealt with; worsening of the original problems; impaired ability to approach or trust other professionals; and additional damage caused by the breach of trust (Devereux 2010). Effects may range from confusion through to suicidal feelings and attempts. The practitioner who violates boundaries will be affected through disciplinary enquiries and professional sanction, up to being removed from their professional register and occasionally through civil or criminal prosecution. Others affected can include colleagues, other patients, the employing organisation, friends and family.

The word boundary stems from the Medieval Latin word ‘bodina’ or ‘butina’, via the Old French word ‘bodne’ and then the Middle English ‘bound’ which also meant ‘landmark’.

The ancient Roman God Janus was known as the god of gates, doors and boundaries, of beginnings and transitions, endings and time, presiding over all beginnings and transitions, abstract and concrete, sacred and profane.

Terminus was the Roman god who protected boundary markers, such as those marking the edge of a town. Sacrifices were performed to sanctify each marker and a festival called the “Terminalia” was celebrated annually. The same etymology produces the word Term, meaning ‘A limit in space, duration’, or ‘that which limits the extent of anything; a limit, extremity, boundary’ (OED).