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Keeping Boundaries

Maintaining Safety and Integrity in the Psychotherapeutic Process

Richard S. Epstein, M.D.

  • ISBN 978-0-88048-660-6
  • Item #8660


Keeping Boundaries is an across-the-board review of the subject of boundary maintenance in psychotherapy. Using a comprehensive approach, this book examines the problem of therapeutic boundaries and boundary violations from multiple viewpoints, including historical antecedents, sociological mechanisms, object relations theory, psychodynamic theory, practical technique, and the mental health and training of psychotherapists. It covers a variety of boundary issues, including dual relationships, informed consent, fees, gifts from patients, maintaining confidentiality, avoiding abuse of power, and helping therapists to protect themselves against exploitive patients.

Written in a clear and jargon-free style, this book provides the therapist with practical clinical advice supported by extensive references and clinical vingnettes.


  • General Aspects of Therapeutic Boundaries and Boundary Violations.

    The nature and function of therapeutic boundaries. Ego boundary development and its relationship to the therapeutic frame. Factors common to all boundary violations.

    Specific Boundary Issues.

    Introduction to section II. Stability: Creating an atmosphere of trust and reliability. Whom should a psychotherapist treat? Problems of patient selection when a dual relationship exists. Respecting the patient's autonomy: maintaining a position of neutrality. Balancing the therapist's financial needs against those of the patient: monetary compensation in psychotherapy. Confidentiality. Maintaining anonymity. Abstinence and the management of erotic feelings in psychotherapy. Treating the patient who tries to exploit the therapist.

    Issues Concerning the Mental Health and Training of Psychotherapists.

    Psychological characteristics of therapists who commit serious boundary violations. Education and self-assessment: how can therapists learn to improve their boundary skills? Appendix. References. Index.

About the Authors

Richard S. Epstein, M.D., is a psychiatrist in private practice in Bethesda, Maryland. He is President-Elect of the Washington Psychiatric Society, Clinical Professor in the Department of Psychiatry at Georgetown University School of Medicine, Washington, DC, and Clinical Associate Professor in the Department of Psychiatry at the Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, Maryland.

For mental health professionals in need of a comprehensive, accessible, erudite guidebook on boundary issues, this book is highly recommended. For professionals involved in teaching about boundary issues, it is an excellent source that covers the most salient and important points. Reading Keeping Boundaries will enhance clinical understanding and ethical behavior for mental health professionals in particular and professionals in general.—Psychiatric Services

This book should be read by all psychiatric trainees and clinicians. It is a comprehensive and practical integration of theory and practice.—Bulletin of the American Academy of Psychiatry and the Law

This book is outstanding and should be read by every psychiatrist and psychiatric resident. It is the first book I have seen that adequately addresses the problem of appropriate behavior on the part of the psychiatrist. Specific problems are explicit, well illustrated by clinical examples, supported by current literature, and preventive strategies are discussed. . . . Dr. Epstein has provided a treatise in this area that will be useful for years to come.—George Dawson, M.D., General Hospital Psychiatry

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