“How do you like those boundaries?”: Metaphor and ontology of therapeutic boundaries

Across the mental health professions, the metaphor of “boundaries” serves to designate a metaethics of therapist–patient conduct that ranges from the clinical setting to the therapeutic relationship. Though once rare, by the 1990s, boundary nomenclature had attained a notable presence, designating tangible limits to therapists’ conduct. Like fences at a precipice, clinical boundaries were introduced to safeguard therapists from perilous missteps. Mapping a variety of potential dangers, the metaphor and associated lexicon evolved most obviously from growing wariness of therapists’ sexual involvement with patients, though was informed too by the rising challenges of litigation, managed care, and the vagueness of professional codes. Being a neologism without language specific to any therapy system, the metaphor transcended many professional disagreements. Intrigued by its endurance as a ubiquitous instrument without philosophical, legal, or empirical grounding, our study explores discursive devices that bolstered its success. Early proponents capitalized on a metaphor's capacity to make visible some forms of therapy and hide others while obscuring an authorial purchase. Terminology like “slippery slope” and “boundary flexibility” highlighted therapists’ vulnerabilities to transgression yet also sustained ambivalence about the parameters of safety. Diagnoses of therapist boundary violators as psychologically impaired shifted attention toward risks facing “normal” as well as disordered practitioners, and case study vignettes enacted boundaries just as they dramatized therapists’ missteps. In its enduring success, clinical “boundaries” joined company with other professional neologisms which were motivated by then-current problems and engineered by professionals in ways that reshaped their work.