Introduction

Estimating the prevalence of boundary violations between mental health professionals and their clients is very difficult. Most research in this area has focused on abuse (rather than boundary violations per se) of clients by professionals, in particular sexual abuse. Public concern in the UK has been heightened by a number of recent well publicised cases of, and inquiries into, sexual abuse of clients within the National Health Service (NHS), such as the cases of Clifford Ayling (see Box 10.1, p. 115), and Michael Haslam (see Box 6.1, p. 65) and William Kerr (see Box 6.2, p. 66) (Paufley, 2004; Department of Health, 2005). There has been little attention afforded to other forms of abuse, such as emotional or physical abuse, and even less to other types of boundary violations, such as financial gain.

There are various sources of data regarding sexual contact between professionals and clients, but the combination of little research and lack of detail in recording procedures results in an extremely unclear picture in respect of the phenomenon of professional–client boundary violation in the British healthcare system. There is also an important issue in relation to under-reporting, with clients, staff and relatives feeling unable to initiate or pursue complaints (Donaldson, 1994).

The available research data, largely from other countries, despite their methodological limitations (see below), suggest that approximately 7% of mental health professionals violate the sexual boundary in therapy and a variety of types of sexual contact occur, with such abuse beginning both during therapy and after discharge. A similar percentage appear to violate the financial boundary. A far greater proportion form social relationships with current or ex-clients and have non-sexual physical contact with them. The prevalence of emotional abuse of clients is impossible to estimate due to lack of research in this regard worldwide, but in the UK information from Witness, a professional boundaries charity (formerly Prevention of Professional Abuse Network, POPAN), suggests that it is not insignificant.

Definitions

In this chapter, the terms ‘therapist’ and ‘professional’ are used interchangeably to refer to mental health workers, and should be taken to refer equally to all those who treat clients or patients within the British mental health system. Similarly, the term ‘therapy’ is used to refer to professional contact between mental health professionals and their clients in a generic sense.