Setting Professional Boundaries: A Guide for Clinicians

Running your own business is a recipe for burnout. Because everything, ultimately, depends on the business owner, it makes sense to give in to long hours and an unsustainable pace of work. Going into private practice is no different.

Even though burnout is the status quo for many business owners, it can be especially untenable for those in the field of behavioral health care. The work is emotionally exhausting by its very nature (hello, compassion fatigue). And, paradoxically, it’s work that depends on the clinician’s emotional sustenance.

To effectively support our clients, clinicians must continually explore the concept of boundaries as it relates to their own private practice. But where to begin?

Defining boundaries for ourselves

Professional boundaries are the overarching frameworks that protect clinicians and their clients from any harm or mistreatment within their therapeutic and working relationship.

It’s especially important to define professional boundaries within the context of behavioral health to avoid any unnecessary harm for both parties. Relevant boundaries for clinicians include communication, organizational, and emotional boundaries.

Areas of focus for boundary-setting

Communication

Communication boundaries encompass the rules that best dictate and fit your personal restrictions regarding client communications.

Organization

Organizational boundaries refer to the limits and guidelines set to protect your private practice while ensuring its operational efficiency and upkeep.

Emotion

Emotional boundaries are the hard limits placed on how much energy and emotions clinicians give in their working relationship with clients.

Ideas for setting new boundaries

Communication, organizational, and emotional boundaries each have their special areas of attention, which clinicians need to approach carefully to avoid any boundaries being crossed down the line.

When analyzing the tips below, it’s important to assert yourself so you don’t end up negating or contradicting any of the progress you’re trying to make.

Setting boundaries around communication

Outline personal preferences within informed consent documents

Informed consent documents provide a valuable opportunity to outline boundary specifications at the beginning of the therapeutic relationship so clients have a clear understanding of what to expect and can decide whether or not this is a good fit. Common boundaries dictated within informed consent documents includes:

• Email/Text Consent: This authorizes you to communicate with clients through email and text.
• Telehealth Consent: This permits you to incorporate video calls as part of your treatment.

Consider reiterating specific professional boundaries during the first session like preferred methods of communication, availability for calls, and expectations regarding no-shows/ last-minute cancellations. Remember that this is an ongoing process, not a one-time thing, and clinicians can bring up any subsequent boundaries that may need to be addressed.

Set up emergency/ crisis plans for when you’re not available

If an emergency arises while you are unreachable, a contingency plan can help your clients in times of need. These plans should include resources both at the state and the national level to fit any specific accommodations. They should also be continuously reviewed and updated for both accuracy and efficiency.

Examples of resources for emergency plans includes:

988 Crisis Lifeline

• Services offered: Free, 24/7 help for those who are in crisis or experiencing distress.
• Who they serve: Anyone.

Call or text 988 to reach a live representative

Crisis Text Line

• Services offered: 24/7 support for those in crisis.
• Who they serve: Anyone.

Text "HOME" to 741741

Deaf Crisis Line

• Services offered: 24/7 crisis support
• Who they serve: Those who are deaf or hearing-impaired.

Video phone: 321-800-3323

The Childhelp National Child Abuse Hotline

• Services offered: Trained counselors to provide resources and support in getting help during a child abuse situation.
• Who they serve: Witnesses of child abuse, adults, parents, guardians, teens and children experiencing abuse.

Call or Text 1-800-422-4453

National Domestic Violence Hotline

• Services offered: Available 24/7. Trained advocates to support domestic violence survivors.
• Who they serve: Adults, couples.

Call 1-800-799-7233 (for TTY: 1-800-787-3224) or text “START” to 88788.

For more information on resources both at the national and state level, visit Alma here.

Setting boundaries around organization

Set expectations on no-shows/ last-minute cancellations

A cancellation policy is important for any private practice because it gives the clinician an opportunity to recoup any lost revenue from no-shows or last-minute cancellations.

While a single cancellation may not seem like a big deal, when you put it into perspective you can see the totality of its impact. For example, if you charge $120 per session and average one cancellation every other week, you can expect to lose over $3000 in revenue over a year.

Consider implementing a 24-hour, 48-hour, or 72-hour time frame for cancellations, which means clients have up to 24, 48, or 72 hours before an appointment to notify you of a cancellation without incurring a fee. If there is a last-minute cancellation, you are entitled to charge your cancellation fee.

Be clear about guidelines regarding payment

Payment can be an awkward and uncomfortable subject, but navigating this boundary effectively is necessary for the stability of your private practice.

Circumvent the issue of missed payments with Alma’s autopay tool, that will automatically charge the card on file when an invoice is created. For more information on Alma’s autopay feature, visit this page to learn more.

Setting boundaries around emotions

Maintain a healthy therapeutic distance from clients

Therapeutic distance is loosely defined as the level of transparency and disclosure within the therapeutic relationship between a clinician and their patient. By establishing healthy levels of therapeutic distance, clinicians may be able to avoid issues like secondary traumatic stress and emotional exhaustion.

Tips for maintaining an effective therapeutic distance from clients include remaining mindful and conscious of self-disclosure throughout the relationship. When self-disclosure is overdone or not done appropriately, it can take the focus away from the client and derail progress.

Keeping strict track of time can also work to maintain a healthy therapeutic distance as it motivates both parties to make the most of the allotted time by focusing solely on making progress towards the clients’ goals.

Listen to your emotions

Being a professional doesn’t make you void of valid emotions. Left unaddressed, these feelings can often fester into more serious issues like burnout and other compromised professional boundaries. You’ll also miss the opportunity to address problem areas in your professional career.

Instead, fully accept these feelings and put effort towards exploring them so you can get to the root of what’s bothering you.

Holding boundaries is holding space for clients.

Most of us time-poor business owners would find it easy to relegate boundary-setting as a luxury we cannot afford. But, for therapists in private practice, it’s an essential consideration that we can’t afford to forgo.

In order to show up reliably for our clients, and to hold a consistent safe space for them, we must draw boundaries that establish that safety.

The “right” boundaries will be different for each of our practices, and there’s no one list of universal rules that can apply to each clinician — or even, each of their clients. But, the right tools can help. Learn more about running your private practice with Alma. →