Pushing the boundaries: reflections on speech-language therapists' relationships with clients in a changing therapy context.
New Zealand Speech-language Therapists' Association
Faculty of Health, Engineering and Science
School of Psychology and Social Science/Social Justice Research Centre
The issue of client-professional boundaries in speech-language therapy (SLT) practice has only rarely been considered in the SLT literature. This paper summarises general guidelines on health professional-client boundaries and which might be the difference between a professional and a non-professional relationship. SLT codes of ethics provide broad recommendations on relationship boundaries and the prevention of boundary violations or breaches of ethical and professional standards. But this issue remains highly complex, not least because the contexts in which SLTs work are changing. For example, models of care are emphasising much richer and more authentic relationships. Increasingly, the SLT profession is expected to adopt client-centred (or family-centred) approaches to intervention, to value the expertise and “insider perspective” of those who seek SLT services, and to view the process of intervention as a partnership. In the light of such shifting expectations of the nature of professional-client relationships, how might professional boundaries with clients require pushing or renegotiation? How is such renegotiation affected by our therapeutic focus on communication and on the importance of “self” in our service? Is the metaphor of the “boundary” a good way to think about such relationships? This paper challenges clinicians to consider how current notions of boundaries might be impacting on services thereby disempowering clients and limiting our potential contribution. SLTs need to debate how to balance the protections and ethical standards enshrined in notions of boundaries with the benefits of authentic relationships and collaborative practices.