Overview

“Boundaries” generally refer to someone’s stated preferences for social conduct and interpersonal engagement that respects their autonomy and integrity.

There are lots of context-specific frameworks and definitions for boundaries. The American Psychological Association (APA) maintains the APA Dictionary of Psychology which articulates two definitions. The casual one reads:

“a psychological demarcation that protects the integrity of an individual or group or that helps the person or group set realistic limits on participation in a relationship or activity.” [^0]

Common boundaries people put forward include privacy around personal details, a limit on the topics one feels comfortable discussing, foregoing physical touch as a form of intimacy, and establishing space to have time to recharge. In healthy relationships, all parties feel comfortable expressing their boundaries with the confidence that they will be respected, and any violations will be identified and corrected.

In unhealthy relationships, where enmeshment and codependency might be present, someone’s boundaries, self-worth, and sense of safety and security can become contingent on someone else’s determination. This can be observed in children who are afraid to express an opinion their caretakers haven’t approved of including desires for physical space, partners in a relationship who routinely violate each other’s privacy like going through their phone when in the bathroom, and employers who ask their employees to do personal tasks unrelated to the job description or success of the workplace environment. Particularly extreme cases can involve stalking, manipulation, and domestic violence and abuse.

Medical professionals, from therapists to physicians to nurses, have an especially delicate appreciation for boundaries since their work requires them to earn the trust of a patient to gain consent for procedures and treatments. There’s a long, unpleasant history of medical institutions condoning boundary violations when a moral framework or personal bias is attached to the condition or person being treated. Recent studies show that simply referring to someone as a “substance abuser” rather than someone with “substances use disorder” can change the way trained professionals view the justification for punitive measures [^1].

To that end, the APA’s dictionary provides a second definition:

“in psychotherapy, an important limit that is usually set by the therapist as part of the ground rules in treatment. Boundaries may involve areas of discussion (e.g., the therapist’s personal life is off limits) or physical limits (e.g., rules about touching), which are guided by ethical codes and standards. Respect for boundaries by both the therapist and client is an important concept in the therapeutic relationship.” [^0]

A more abstract definition of “boundaries” in the context of professional conduct for medical workers from the Indian Journal of Psychological Medicine reads:

“A boundary may be defined as the ‘edge’ of appropriate professional behavior, transgression of which involves the therapist stepping out of the clinical role or breaching the clinical role. Boundaries define the expected and accepted psychological and social distance between practitioners and patients. Boundaries are derived from ethical treatise, cultural morality, and jurisprudence. Sometimes, it is difficult to clearly define the perimeter of these boundaries and the integrity of the relationship.” [^2]

Boundaries come up very commonly in recovery circles as substance use is often a coping mechanism for managing violated boundaries, and it can lead to behaviors that violate the boundaries of others. A typical story of an addiction trajectory might involve someone growing up in an abusive household that regularly ignored their physical and emotional boundaries, so they used substances to cope with the distress, and then they end up stealing from others around them in order to sustain their substance use. A less overtly harmful pattern is simply texting or calling people at late hours for company under the influence after the bedtime they’ve indicated they’re trying to maintain.

The Society for the Advancement of Psychotherapy, Division 29 of the APA, discusses some of the specifics of boundaries within the context of clinical psychotherapy:

“Boundaries provide:

“A therapeutic frame which defines a set of roles for the participants in the therapeutic process” (Smith and Fitzpatrick, 1995, p. 499)
“a foundation for this relationship by fostering a sense of safety and the belief that the clinician will always act in the client’s best interest (Smith & Fitzpatrick, 1995, p. 500)
a “distinction between the expectations and interactions that would be considered appropriate within the relationship and those that would be considered inappropriate within the relationship” (R. Sommers-Flanagan, Elliot, & J. Sommers-Flanagn, 1998, p. 38).

They also break down the types of boundaries in psychotherapeutic contexts into touch, time, space, location, gifts, and self-disclosure. A recurring theme in [[the-sopranos|The Sopranos]] is the frustration experienced by opening up to a therapist in a way that feels intimate but having to adhere to professional codes of conduct that limit what can be done with that exposed vulnerability. Within the show, Tony regularly tests his own therapist’s boundaries across all of these dimensions, and though she herself is tempted to often cross them, she acts as a rare beacon in the show’s corruption and abandonment of ethical codes. Something as innocuous as bringing a cup of coffee to a session to share with a therapist can be seen as a form of gift-giving that opens the door to the complexities of interpreting material exchanges between patient and practitioner. We perhaps can’t expect perfect adherence to boundaries in any context, even among highly trained and ethically-grounded professionals, because human relationships are inherently messy with missteps and mistakes. For better or worse, professionals are human too.