2.7 The failure of CAM therapeutic relationships: breach of boundaries
In this section, failures caused by breach of boundaries are discussed under the following headings:
creating dependency to satisfy practitioners’ emotional and financial needs
sexual abuse and exploitation.
To reiterate a point made earlier, breaches of the therapeutic relationship cover a spectrum. Some breaches invariably thwart a successful therapeutic outcome (for example, when a therapist is physically aggressive and intimidating towards a patient). Other breaches may inhibit a maximally effective therapeutic outcome, but do not necessarily destroy the entire foundation of the relationship (for example, a therapist who tells the user more about their personal circumstances than the user cares to know). The most unacceptable sorts of breach tend to be expressly prohibited within practitioners’ codes of conduct. Professional bodies in CAM prohibit sexual relationships between practitioners and users or former users, or direct financial relationships, such as borrowing or lending money. (For example, see the codes of ethics for osteopaths and chiropractors: General Chiropractic Council, 2004; General Osteopathic Council, 2004.) Other breaches are more subtle and less well documented. While the focus here is on CAM relationships, it is important to remember that breaches of boundary occur in all health and caring professions (POPAN, 2000).