Boundaries in Addiction Treatment

Skilled, experienced therapists can make a world of difference for individuals in drug and alcohol treatment and rehab, but an effective therapist-client relationship requires counselors to establish clear boundaries that maintain trust and professionalism.

Healthy client-counselor interactions governed by ethical boundaries are in the best interest of both, and should be established by the counselor at the onset of treatment with each new client. Clinicians generally take this responsibility very seriously. Those who fail to establish and maintain boundaries are at risk of discipline, dismissal, and in extreme cases, termination of licenses.

Not Always Black and White

Closely guarded boundaries can reduce opportunities for unintentional exploitation of a client’s trust. While it’s normal for clients to develop feelings for a counselor who has helped them through some very difficult times, including the sharing of personal, private experiences and painful emotions, some boundaries aren’t black and white.

For example, a friendly hug may seem like an innocent gesture (and it usually is), but a hug can be wrought with meaning for the client, making it an innocent but risky form of boundary crossing. This can create a dilemma for a therapist who knows that some clients would benefit greatly from a quick embrace.

Keeping Personal Lives Separate

Although it’s difficult at times, it’s important for clinicians to be friendly, but not to develop personal friendships with clients. Most counselors are admonished not to accept gifts, engage in any type of personal contact, or impose their religious and moral beliefs and values on their clients.

Many are careful not to talk about themselves and their lives away from drug and alcohol treatment and rehab, and some avoid placing pictures or personal items in their offices, which serves to delineate a stronger boundary between the client and a clinician’s private life.

Counselors in Recovery

It’s not at all uncommon for counselors to be in recovery for their own drug or alcohol addiction, although most treatment centers require potential counselors to prove they have been clean for at least three years.

Frequently, clinicians who are former addicts develop compassion and empathy that makes them very effective counselors. However, boundary lines may be blurred when counselors, without realizing it, have trouble separating their work from their own recovery process. Frequently, it’s best for counselors in recovery not to share too much information about their personal experiences with substance abuse and addiction.

Many counselors attend various support groups, and clinicians may find themselves at the same meeting as a current or former client, especially in rural areas or small communities. Twelve-step groups call these clinicians “two hatters” because of their dual role as a counselor in recovery.

Counselors in recovery must carefully manage their own ongoing recovery, as nobody is immune to relapse, even therapists who have been clean for many years. Clinicians must recognize their own points of vulnerability and learn effective ways of coping with stress.

Relationships between Client and Counselor can be complex

While client-counselor relationships can be complex, ethical practices should drive every interaction. Most counselors rely on guidelines set forth by organizations such as NAATP (the National Association of Addiction Treatment Providers) or ISSUP (the International Society of Substance Use Professionals).

At Paracelsus, we carefully choose our counsellors and can proudly say that many have worked with us for many years in the most complex and intricate situations.

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